HCI3 Releases Episode of Care Definitions to Further Support Payment Reform and Cost and Quality Analysis

More than 80 procedures and conditions now available; goal is 80% coverage of all costs of care by 2015

NEWTOWN, CT —  A new milestone toward health care payment and delivery reform has been reached with the release of more than 80 Evidence-informed Case Rate (ECR®) definitions from the non-profit Health Care Incentives Improvement Institute™, Inc. (HCI3). An ECR is an entire episode of care that includes all covered services across all providers that would typically treat a patient for a single illness or condition. ECRs can be used for multiple purposes including bundled and accountable care organization payment programs, reference-pricing initiatives, and provider cost and quality analysis.

Over 80 open source ECRs have been created to date, all of which are available for public use at no cost as part of HCI3’s mission to improve the quality and affordability of care and to address the need for scientifically designed and validated episodes of care that have a multi-purpose use. By making the ECRs widely available, implementations of payment reform programs and cost and quality analysis initiatives have a comprehensive starting point from which to build.

“Our goal is to develop enough ECRs to cover 80% of costs of care by 2015,” said Francois de Brantes, HCI3 executive director. “While we’ve seen momentum towards implementation of bundled payments, many stakeholders weren’t aware that definitions of episodes of care are readily available. We’re working to help expedite and simplify health care payment and quality efforts for providers, plans, employers and ultimately consumers.”

HCI3’s ECRs are unique in that they are the only definitions that distinguish typical and routine services from those associated with potentially avoidable complications which are any event that negatively impacts the patient and is controllable by the provider; can flag potentially avoidable services (identified as overused by the American Board of Internal Medicine Foundation’s Choosing Wisely initiative) and include core services for certain conditions based on evidence-based guidelines to identify gaps in care.

“Making this type of information public is a positive step in creating a three-dimensional picture of health care costs,” said Robin Gelburd, president of FAIR Health, a national non-profit organization focused on bringing transparency to health care costs and health insurance information. “We look forward to exploring how ECRs can enrich the transparency tools we offer on our consumer website. The industry and research community can also combine ECRs and FAIR Health data to design innovative payment and reimbursement models to determine the frequency and costs of episodes of care to inform policymaking, best practices and public health initiatives.”

Funding for initial development and testing of the ECRs came from charitable foundations including the Robert Wood Johnson Foundation, The Commonwealth Fund, the New York State Health Foundation, and the Colorado Health Foundation. These episodes were built with the help of physicians who are experts in their respective fields, often members of their specialty societies, who volunteered their time and assembled in Clinical Working Groups. The ECRs are run through different test databases and refined based on empirical evidence and feedback from the field to ensure validity and reliability. Many health plans and employer coalitions have and are continuing to use ECRs as the basis for their bundled payment programs.

Today, HCI3 independently funds the ECR creation process, accepting no financial support from medical societies, pharmaceutical companies or medical device vendors to ensure the ECR definitions are free of bias.

Clinical ECR Webinars
To assist providers with understanding ECR concepts and their creation, HCI3 is offering free monthly webinars, which will examine the makeup of an ECR, or group of related ECRs and the development process. The first webinar will be held on September 23 at 7pm ET with Joel Brill, M.D., Medical Director of FAIR Health, as he reviews the use of ECRs in the context of gastroenterological episodes including colonoscopy, upper GI endoscopy (EGD), and gastro-esophageal reflux disease (GERD). Register for the webinar here. A list of upcoming webinars can be found on the HCI3 website here.

About Health Care Incentives Improvement Institute™, Inc.
The Health Care Incentives Improvement Institute, Inc. (HCI3) is a not-for-profit multi-stakeholder umbrella organization for Bridges to Excellence® and PROMETHEUS Payment®. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. health care system.