There is a popular myth that laparoscopic surgery is always safer than regular surgery because it reduces the potential for wound infections and complications associated with longer lengths of stays. In many instances, that myth is validated. However, for this particular surgery, our analysis indicates the opposite is true. Data in this issue brief show laparoscopic surgeries yielding...
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PROMETHEUS Analytics© is perhaps the most comprehensive system available for analyzing provider performance, and developing and implementing value-based payment models around episodes of care. A critical feature of any episode grouper is the application of appropriate methods of risk adjustment to accurately and fairly account for individuals’ insurance risk in relation to episode costs. The...
Uncovering any inefficient spending or low-quality care associated with as prevalent and costly disease as diabetes holds the potential to save money for payers and improve outcomes for patients. A critical step toward those twin goals is to identify variation in the cost and quality of diabetes care, and isolate opportunities for improvement. That’s what we’ve done in this analysis, using...
Even before the Affordable Care Act, Horizon Healthcare Services of New Jersey set out to change how healthcare is delivered. A few years into its initiative, the company runs the largest commercial Episodes of Care (specialty-value-based) program in the country, and is delivering impressive results in quality, patient experience and cost reduction.
Read the case study (below), and an...
Introduction
As the US health care system moves towards value-based payment, it becomes clearer that, while alternative payment models are important, the underlying information processes required to vivify these new payment models are equally critical to the success of the payment model. As much as Patient Centered Medical Homes, Accountable Care Organizations and episode-based...
To help all states significantly improve their grades and provide important quality information on physicians, we have developed a rigorous methodology to calculate outcomes of patient care. The methodology is detailed in this companion White Paper to the Report Card. This model can be used to measure complications of care for a large variety of medical conditions, illnesses, and procedures....
Bundled Payment: Why Employers Should Care
Since the passage of the Employee Retirement Income Security Act (ERISA) in 1974, many employers, especially larger ones, have turned from the costlier practice of purchasing health benefits from health plans in state-regulated marketplaces. By “self-funding” employee health benefits, where the employer acts as a mini health plan, employers...
Episode Analytics to Guide Your Value-Based Care Transition
A value-based payments analytics platform designed for health plans that want to foster deep clinical and cost analysis through episodic claim grouping and network analysis.
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