Value-Based Care and Payment Models
Assess costs of care and estimate appropriate budgets for value-based payment models
To move to value-based care delivery and payment, your plan has to analyze, understand and manage episode-based care information. The new care and payment models require a new set of sophisticated analytic tools that help ensure that all stakeholders have a complete understanding of current performance and an ability to confidently predict and manage the financial and clinical risks and rewards associated with contracting for value.
" The significant variations in provider costs and clinical patterns complicate contract negotiations and quality measurement. With SAS® we can fully integrate surgeons and other health care professionals into all levels of care, creating possibilities for cost containment and quality improvement."
— Michael Occhipinti
Director of Informatics
Horizon Healthcare Services Inc.
How SAS® Can Help
SAS and the Health Care Incentives Improvement Institute (HCI3) have developed an advanced analytics solution that is based on the principles of HCI3's earlier, groundbreaking PROMETHEUS Payment® ECR (Evidence-Informed Case Rate®) Analytics system. SAS® Episode Analytics allows health plans to assess costs of care for plan members and estimate appropriate budgets for various value-based payment (VBP) models such as bundled payments, medical homes and accountable care organizations (ACOs). With SAS, you can:
- Better predict costs of care and enhance the budgeting process. Gain broader insight that transcends an individual episode by seeing clinically validated definitions of hierarchical relationships between episodes. This allows you to not only have a more comprehensive view of a member’s health, but also the expected costs for members by episode of care.
Provide incentives for improved outcomes, reduced costs and other aspects of patient care. Armed with this information, plans and providers can better collaborate and coordinate care across providers through an episode, and use the framework to pay providers for value and incentivize improved quality.
- For the most common clinical episodes, track potentially avoidable variation in care delivery and the associated financial implications.
- Identify the best opportunities to minimize care variation to reduce cost while maintaining quality.
- Identify areas for program development and performance improvement.
- Contract in bundled payments, shared savings, capitation payment models and other forms of at-risk contracts. By clearly identifying the procedures and services of an episode of care (as well as expected costs), you can create contracts based on agreed-upon payments for episodes.
- Create fair comparisons across providers by adjusting for member severity. Associate an accountable provider to a member’s entire bundle of care. Understand any provider-specific variation in cost, as well as member-specific expected variability due to health status, allowing you to compare the expected costs for an episode or set of episodes.
How SAS® Is Different
- A holistic view of the member. With SAS, you can understand the complexities of managing a member and potential variations that lead to complications. By analyzing the relationships created between episodes and episode classes, you can understand and craft new approaches to addressing the underlying reasons for variations in per-member reimbursement cost.
- Assurance of data quality. SAS uses quality assurance gates for incoming data to ensure completeness and reliability.
- Integrated risk adjustment. With SAS, you can integrate risk adjustments to better understand member complexities and possible comorbidities – something that isn’t possible with basic grouper offerings.
- A proven solution. Based on HCI3's PROMETHEUS Payment ECR Analytics, SAS offers a proven solution for health plans to evaluate and manage bundled payment and Shared Savings models. Based on the strong pedigree of the PROMETHEUS Payment System, it includes all the knowledge and feedback from the pioneers who adopted the earlier software.
- Speed and ease of deployment. Using the software-as-a-service (SaaS) model improves time to value, is highly secure, provides a scalable architecture and allows you to quickly gain advantages of new releases.
Related Products and Solutions
SAS® for ECR Analytics™
As the health care industry adopts value-based models, providers need to analyze episode-based patient care and attendant costs from granular to holistic levels. SAS provides a set of sophisticated analytic tools that give all stakeholders a complete understanding of current performance, as well as an ability to confidently predict and manage the financial and clinical risks and rewards associated with contracting for value.
Ready to learn more?
Call us at 1-800-727-0025 (US and Canada) or request more information.