**HOLD - do not publish**A better way to pay for health care: Analytics powers bundled payments

U.S. physicians and hospitals have historically been rewarded for the number of services performed rather than coordinating patient care. As momentum builds to replace this system with a bundled payment model, health care providers and plans must make sense of staggering amounts of patient and payment data. The latest version of SAS® Episode Analytics can help them meet this challenge.

“To change the way care is delivered we need powerful analytics to create a deep understanding of the entire patient experience around an episode of care,” said Alexis Miller, V.P. of Provider Reimbursement at Highmark Inc., one of the largest health insurers in the U.S. and the fourth-largest Blue Cross and Blue Shield affiliate. “SAS Episode Analytics helps us and our provider partners recognize and prevent avoidable complications, reduce variations in cost and quality, and ensure accountability for patient care. The tool allows Highmark to consistently see complete episodes of care down to the individual patient or provider level, as well as how they relate to one another.”

SAS Episode Analytics helps health care organizations like Highmark:

  •         Identify potentially avoidable medical complications.
  •         Build clinical associations between episodes to create the true picture of the patient.
  •         Compare expected versus actual costs, adjusting for risk, to achieve an accurate cost of a patient’s episode.
  •         Reduce excess care utilization and minimize avoidable complications, such as errors and infections.

SAS Episode Analytics draws on the principles of the groundbreaking PROMETHEUS Payment software from the Health Care Incentives Improvement Institute (HCI3), a pioneer in bundled payments. The redesigned SAS software’s comprehensive view of patient care makes it easier to adopt value-based payment models. These include bundled payments and multiple types of capitated models associated with accountable care organizations.

Episode analytics

An episode of care includes all services typically needed for a specific condition or procedure, such as knee replacement. These services are included in a clinically validated episode, adjusted for the severity and complexity of a patient's condition. The SAS software groups relevant claims across the entire span of services, pre- and post-care, then provides personalized, comparative costs for each episode. Health plans and providers can project a budget for specific medical care within a defined time. That knowledge supports bundled payment contracts, which provide a single fixed payment for all providers (hospital, physician, physical therapy, etc.) involved in a care episode. 

“Providing consistent care is an essential component of any value-driven health care system,” said Graham Hughes, M.D., Chief Medical Officer of the SAS Center for Health Analytics and Insights. “SAS Episode Analytics has been designed to do just that: allow health plans and care-delivery systems to create agreements that will benefit patients. Analytics takes the guesswork out of managing risk by setting specific, achievable and measurable targets in both cost and quality associated with episodes of patient care.”

The newest version of SAS Episode Analytics now includes more than 80 standard episode definitions for individual procedures from joint replacements to treatment of chronic conditions such as diabetes, and enables a deeper dive to identify avoidable complications. The ability to explore and analyze large data sets for faster, more accurate information has also been incorporated with SAS® Visual Analytics.

About SAS® for health analytics

SAS for health analytics encompasses the technologies and skills needed to deliver business and clinical insights into the complex interdependencies that drive medical outcomes, costs and oversight. Through modeling, optimization, predictive analytics and business intelligence, organizations can strengthen financial performance, deepen consumer relationships and improve health care delivery for better outcomes across the entire spectrum of health industries. Blue Cross and Blue Shield of North Carolina, Crouse Hospital, Highmark and Kaiser Permanente are among the leading health care organizations that use SAS. Visit the SAS for health care providers and SAS for health insurance web pages for more information.


About SAS

SAS is the leader in analytics. Through innovative analytics, business intelligence and data management software and services, SAS helps customers at more than 80,000 sites make better decisions faster. Since 1976, SAS has been giving customers around the world THE POWER TO KNOW®.


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