Summary of analytic components in selected episode groupers.
| Product | Episode example | Sample conceptual focusa | Number of episodes | Clinical setting | Public episode definition | Linked risk-adjustment approach |
|---|---|---|---|---|---|---|
| 3M Patient-focused Episode Software | Not reported. | • Event-based episodes per patient • Cohort-based episodes among patients with a shared condition or characteristic | >500 | All | No | 3M Clinical Risk Groups |
| Cave Grouper | Urinary tract infection | • Physician relative efficiency and effectiveness scores • High-cost patient prediction | >500 | All | No | CCGroup MediScreen |
| CMS-BPCI | Urinary tract infection | Inpatient and post-acute care | ~50 | Inpatient, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency | Yes | No |
| McKinsey & Company | Perinatal | Principal Accountable Provider | >100 | All | Yes | Yesb |
| Optum Symmetry Episode Treatment Groups | Pregnancy, with delivery | • Patient total cost of care by condition categories • Provider profiling | >500 | All | Yes | Optum Symmetry Episode Risk Groups |
| OptumInsight Symmetry Procedure Episode Groups | Radical hysterectomy | • Medical and surgical procedure cost • Provider profiling | ~200 | All | No | Optum Symmetry Episode Risk Groups |
| Prometheus Analytics | Pregnancy | Potentially avoidable complications | ~100 | All | Yes | Prometheus Analytics risk adjustment |
| Medical Episode Grouper | Cardiac arrhythmias | • Population profiling • Provider profiling | >500 | All | No | Disease Staging and Diagnostic Cost Groups |
Information as of January 2019 in public documentation reviewed for this article, which comprised peer-reviewed articles and Internet searches for vendor product names; sources as cited in the References list. Readers are encouraged to check those and related sources for more details and updated information on the groupers briefly summarized here.
CMS-BPCI Centers for Medicaid and Medicare Services’ Bundled Payments for Care Improvement.
aAs highlighted in public documentation primarily from vendors; this is not an exhaustive list of conceptual orientations among profiled groupers.
bNot detailed in public documentation reviewed for this article in cited sources.
