Case Studies

Episode-of-Care Reporting

Client: Insurer, 2002

Episode-of-Care Metrics Evaluated for Care Variance Reporting

During the managed care era, group practices grew larger as independent practitioners sought the safety of salaried arrangements. About the same time, claims-based episode grouping engines grew in popularity amongst plans and insurers with large data repositories.

As medical cost inflation resumed in the late 1990s, the question arose: Is it feasible to derive aggregate measures of a group practice’s episodic cost efficiency from the performance of its constituent clinicians? This project addressed that question and identified the circumstances in which such aggregation is not appropriate.