Moving to value-based health care with episodes of care


The move to value-based payments is well underway and accelerating. The shift is putting unprecedented pressure on health care providers to better manage the cost and quality of care they deliver. Who will have a much better shot of success? Organizations that understand how well they are performing, where they have opportunities to improve and, their capacity to redesign care delivery.

In fact, the acceleration to value-based payments is being fueled by encouraging results from the field. Many strategies, whether technology or labor-intensive, are helping providers deliver better value and are bending the cost-curve.

Unfortunately, it’s challenging, slow and expensive work without guarantee of success.  Strategies and interventions may not be efficient enough to scale beyond targeted populations or pilot programs. Given limited resources, providers must to be smarter about where they invest and how they execute those strategies.

This is where SAS can help. SAS applies advanced analytics to complex clinical and financial data so providers can be more efficient in selecting and acting on opportunities. For providers under financial risk for the cost and quality of care they deliver to their patients, SAS has SAS® Episode Analytics.

Episodes of careThis solution derives clinically relevant episodes of care from patient service and diagnosis information. Episodes such as a joint replacement, stroke or congestive heart failure are defined collections of services spanning the care continuum over a period of time. While services related to the patient’s condition are differentiated from those that aren’t, the solution also identifies which services are potentially avoidable (e.g. infection, readmission or adverse medication event.) This is invaluable to help providers bring the clinical team into the improvement process because it provides clinical evidence that can drive change.

Imagine a new lens through which  you can view the quality of care delivered across the entire care continuum. Providers haven’t had this in the past. When you apply this lens to a population of patients, providers understand which clinical conditions are driving health care spending and how much of the care delivered is related to complications.  Automatically construct episodes of care based on standardized (or your organization’s customized) episode definitions. The standard episode definitions cover:

  • Chronic conditions.
  • Procedures.
  • Acute medical events.
  • System related failures.
  • Cancer.
  • Obstetrics.

Depending on the population, these episodes capture as much as 85 percent of inpatient costs and 60-70 percent of overall medical costs.

You can gain more insights through other advanced capabilities, including:

  • Methods for attributing providers to episodes to promote accountability and comparison.
  • Risk and severity adjustments to explain variations in cost and provider performance.
  • Association of a patient’s episodes to each other to understand causality and unintended consequence.
  • Customization of episode definitions for differing population, contracting and provider needs.

When providers use episodes of care as a foundation for measuring their performance, they're better equipped to succeed with new value-based payment models. With SAS Episode Analytics, providers have the information they need to:

  • Identify and target poor quality, high-cost and unwarranted variation.
  • Engage clinicians and support staff in performance improvement around quality issues.
  • Design care pathways and programs to optimize outcomes.
  • Plan and budget with greater confidence.
  • Model contract scenarios and support negotiations with health plans.

Analyzing how services are delivered by episodes of care will be a key differentiator for health care providers as they transition to value-based payments. Episodes of care bring the focus on cost and quality to the true outputs of health care delivery.

Interested in learning more about how SAS can help you accelerate your successful transition to value-based payments? Join us at HIMSS Annual Conference 2015, April 12-16, 2015 in Chicago; Booth 4016 in the South Hall.


About Author

Peter Chingos

Sr Industry Consultant

Peter Chingos has over 25 years of experience in health care management, consulting and business analytics. Throughout his career, Peter has focused on large-scale, strategic initiatives to improve quality and efficiency in health care delivery.

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