As the new CMS ruling for hospital chargemasters impacts how they display their pricing, organizations will need to ask themselves big questions about how to make their pricing more strategic, transparent and defensible for consumers, the media and their own peace of mind.
Top 5 Episode Analytics Questions Answered
As healthcare providers continue to move toward value-based care models, data and analytics will continue to play an important role. In 2017 alone, U.S. hospitals cared for over 36.5 million admissions. As this number continues to grow, providers will need to understand their patients not only as they pass through their own care journey, but also as their journeys coincide with a similar patient population and care pathway. Below, we answer five questions about episodes of care and how the healthcare industry is using data analytics to drive higher-quality care and improve overall operations.
What are bundles?
The Institute for Healthcare Improvement cites a bundle as a “structured way of improving the processes of care and patient outcomes: a small, straightforward set of evidence-based practices – generally three to five – that, when performed collectively and reliably, have been proven to improve patient outcomes.”
So, what makes healthcare bundles so special? Bundles (or episodes of care) are backed by research, built with elements that are necessary and sufficient to provide the patient with the best possible outcome. More than a checklist, a true bundle includes all services provided to a patient for a particular condition within a specific period of time across a continuum of care.
When a hospital engages in a bundled payment contract with a payor, these services are paid together for all services, differing from the typical fee for service environment we see today. Bundled payments encourage care coordination and cost reduction strategies for hospitals that engage in these arrangements.
Do all healthcare providers use bundled payment methodologies?
While not all healthcare providers have begun entering into bundles with payors, the industry is beginning to shift toward a need to understand the patient’s journey across the continuum of care. At the root of these episodes of care, hospitals and healthcare providers want to develop a comprehensive look at a patient or patient population as they pass through various doctor’s offices, specialists, labs, operating rooms, and rehabilitation facilities.
Can I leverage episode analytics if I don’t have bundled payment methodologies?
As hundreds of thousands of patients pass through healthcare systems and hospitals each year, organizations will need to develop ways to reduce variation among patients who are following similar care pathways. Regardless of whether they already are paid based on episodes of care, healthcare providers will need to keep an eye on clinical and financial variation, using analytics that allow them to find opportunities to automate the reduction of that variation.
What other problems can I solve with episode analytics?
Those same organizations may want to assess linked physician and hospital billing. They may see the need to track high-cost patients over time for monitoring. Still, they may need to assess care and outcomes variation at different points in the patient journey. Overall, healthcare providers will need to develop a better understanding of variation within their patient populations, using accurate cost accounting data to make decisions and reach cost and margin targets.
Where do I begin?
To define and analyze episodes of care across the continuum, succeed in value-based care by minimizing variation, build complex criteria into your episodes, and automate performance tracking of financial success and key indicators, you’ll need a purpose-built analytical tool. You’ll need to define your episodes via trigger events, episode time frames, and complex inclusion and exclusion criteria.
You’ll need to develop standards for monitoring performance of your patient cohorts, and you’ll need to be able to assess both controllable and uncontrollable variation sources. Finally, you’ll want to automate this process, so that you can focus on leveraging the learnings from this data to drive improvements, negotiate with payors, and help facilitate collaborate discussion with clinicians.
To find out more about how you can begin to understand variation across patient populations and at the patient level, download the Episode Analytics one-pager.
Read about the full modular, cloud-based platform solution StrataJazz® and schedule a personalized one-on-one session with a member of our team to learn more about how our tool can enable your organization to reduce variation and drive high-quality care.