A Practical Guide to Analytics for Governments by Marie Lowman

Author:Marie Lowman
Language: eng
Format: epub
ISBN: 9781119362852
Publisher: Wiley
Published: 2017-05-02T10:00:00+00:00

During one analytic study involving a state Medicaid data set covering approximately 100k patients and 2 years of data, the study found over $100 million in potentially avoidable complications costs representing over 25 percent of the allocated costs of episode care (Figure 4.3).

Figure 4.3 State Medicaid data analysis results show episode costs. Note the over $113 million in potentially avoidable costs.

Cost Allocation

Since episode analytics are based on claims, and most value-based payment methodologies are also sourced from claims, cost allocation is vital. A single healthcare claim can have multiple services listed and if the claim is not properly analyzed, costs could accidentally be attributed in their entirety to one provider who should not be responsible. Therefore, it is important to understand how to allocate the services provided from a single claim across multiple relevant episodes, while also providing a provider attribution methodology to ensure the appropriate provider is being assigned. This enables the benefit of accurately measuring the quality of care by attributing all relevant services provided to the appropriate provider and avoiding under- or overrepresenting costs of episodes due to lost services that aren’t split and counted toward the appropriate episodes. This is particularly important to get a true picture of costs associated with an episode and provider while ensuring that providers are comfortable with the service- assignment methodology and that the claim service-assignment process is fair and representative.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.