Episodes of Care

Decision Support
Shift your focus from the value of products and services to the value of care

Quality

Value Analysis

Many organizations are realizing that to drive desirable patient outcomes, their value analysis strategy must expand beyond traditional cost reduction to consider life cycle costs, evidence-based care and clinical benefits.

Our episodes of care program helps connect clinicians and physicians with finance and supply chain to optimize supply costs, improve patient care and increase a member’s total value of care across the continuum.

The Affinity Episodes of Care solution uses a proprietary supply savings platform to automate the clinical value analysis process. This further improves cost performance and quality outcomes by increasing the visibility of initiatives and savings achieved across the organization.

Episode

Encounters

Assign Episode to Encounters

An episode to encounter assignment identifies the encounters that fall into an episode of care for a consumer. You can then run reports to view the data for the episode of care.

To set up an episode to encounter assignment, you define and select the population of encounters that you want Decision Support to use when it searches the database for an episode of care. The assignment uses the population and the parameters you defined on the Episode Model General Information screen when you run the assignment.

The assignment process matches the encounters you defined in the population to the trigger services you defined in an episode model.

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Identify First Encounter

Decision Support identifies the first encounter that matches as the trigger encounter. This encounter defines the acute phase of the episode using the admission and discharge dates as the start and end of the acute phase.

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Number of Defined Days

Decision Support adds the number of days you defined in the episode model for the pre-admission and post-discharge phases to determine the full date range for the episode of care.

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Identify Other Encounters

Decision Support uses the consumer number associated with the trigger encounter to identify other encounters as part of the consumer’s episode of care. It searches for the additional encounters using the services in the pre-admission, acute, and post-discharge phases of the episode model.

If an encounter matches an included service in the episode model, Decision Support adds it to the episode of care.

Meaningful

Insight

In an episode of care, let’s consider a patient who undergoes knee replacement surgery followed by a 90-day post-acute period. We must consider the entire episode, starting from the moment the decision is made to have surgery to the end of post-acute care. The data can help predict the different providers the patient will see over the course of the episode. It can also provide meaningful insight to the points of care which tend to fragment as the patient goes from one provider to the next for reasons such as communication breakdowns or conflicting treatment plans.

Looking at the evidence within an episode of care underscores the need for efficiency between all providers. Obviously, they try to put forth the best possible care across the entire episode but all too often, there is fragmentation and the overall mission of value-based care can be lost.

Episodic data is critical and compelling. Organizations that are operating in this type of environment should dig through their data for these important performance takeaways:

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Value Analysis Table

The need for supply chain to come to the value analysis table with valid, precise, transparent information is paramount. Autonomy is important when making patient care decisions, but it needs to be tempered by an insightful assessment of the data. Find and present hard evidence that patient outcomes can be improved and adjust processes and care delivery methods.

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Identify Significant Variables

Identify the rationale if significant variability among providers in episodic spending is found. Is it due to one provider delivering a higher quality of care with measurably better outcomes that justifies the higher expenditures?

Most often, the answer is no. It is expected there will be a slight variance, e.g. 4-5 percent as opposed to a more significant 200-300 percent. If a provider is spending more than others, what is the reason?

By mining episode-of-care data in this way, an organization can identify areas of cost drivers that must be addressed to gain efficiencies and improve care. In addition, episode of care offers the opportunity to look at the patient experience in a very granular way – by specific patient.

A granular view is very compelling to physicians and can’t be underestimated— it results in instant validity and credibility.

The value of episodic data is also important at the facility level where the concern is that post-acute cost is a key driver of episodic spending. It motivates hospitals to find ways to improve their delivery of care to reduce post-acute episodic costs, like re-admissions.

In a recent example: Hospitals engaged in bundled payments that experienced 30,000 knee episodes and 16,000 hip replacement episodes, spread out over an 18-month period. After evaluating the data, they discovered a reduction of episodic cost as the hospitals got more operationally efficient in their processes, and there was also a simultaneous decrease in length of stay. This demonstrates the facilities evaluated their episodic data and cost variations, made adjustments in their care delivery model and improved both efficiency and cost levels.

The right data can effectively highlight both processes and outcomes that need to be improved, as well as suggest what the best tools for improvement should be. Providers share in the risk and reward of managing the episode of care, so it’s in their best interest to evaluate the data and collaborate to increase efficiency.

As value-based care increasingly rewards better outcomes, providers will seek to align with health systems that support mutual success.

More Info
  • Develop and maintain cost standards
  • Allocate actual cost, overhead, and direct, variable, and fixed costs to calculate encounters
  • Run customized “what if” scenarios across your entire organization
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  • Identify episodes, understand profitability and define costs across the care continuum
  • Analyze various episode types, such as transplant cases, re-admissions, and CMS-defined BPCI1 and CJR2 bundles
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  • Integrate all aspects of the payer contract process, including negotiation, contract planning, expected payment calculation, compliance and monitoring
  • Analyze government and non-government payer contracts
  • Conduct robust pricing and reimbursement modelling
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  • Set various budget types, including operating, flex, employee-level, and job code budgets
  • Monitor financial performance trends through embedded workflow and dashboard reporting functionalities
  • Model impact of current and future key decisions
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  • Enable enterprise-wide visibility into everyday financial, clinical and operational impact with advanced dashboards
  • Customize and schedule your desired data to easily spot trends, benchmark results and measure performance

TESTIMONIALS

What People Are Saying

Affinity Decision Support’s drill-down is definitely our favorite feature. It allows for financial management decentralization and cuts down on telephone calls to AP and payroll offices

Katja Waldman

Director of Finance,

A 450-bed, nonprofit medical center located in the Northwest used Affinity expertise and decision support solution to identify care variation among its physicians. We worked with the member to reduce care variations and implement standardized care pathways, saving $21.8 million in three years.

$21.8M

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Herndon
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info@harrisaffinity.com

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