Showing posts sorted by relevance for query clinical risk groups. Sort by date Show all posts
Showing posts sorted by relevance for query clinical risk groups. Sort by date Show all posts

July 2, 2019

Episode groupers: a crucial tool for population health management

A practical guide to episode groupers for cost-of-illness analysis in health services research

Summary of analytic components in selected episode groupers.

ProductEpisode exampleSample conceptual focusaNumber of episodesClinical settingPublic episode definitionLinked risk-adjustment approach
3M Patient-focused Episode SoftwareNot reported.• Event-based episodes per patient
• Cohort-based episodes among patients with a shared condition or characteristic
>500AllNo3M Clinical Risk Groups
Cave GrouperUrinary tract infection• Physician relative efficiency and effectiveness scores
• High-cost patient prediction
>500AllNoCCGroup MediScreen
CMS-BPCIUrinary tract infectionInpatient and post-acute care~50Inpatient, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agencyYesNo
McKinsey & CompanyPerinatalPrincipal Accountable Provider>100AllYesYesb
Optum Symmetry Episode Treatment GroupsPregnancy, with delivery• Patient total cost of care by condition categories
• Provider profiling
>500AllYesOptum Symmetry Episode Risk Groups
OptumInsight Symmetry Procedure Episode GroupsRadical hysterectomy• Medical and surgical procedure cost
• Provider profiling
~200AllNoOptum Symmetry Episode Risk Groups
Prometheus AnalyticsPregnancyPotentially avoidable complications~100AllYesPrometheus Analytics risk adjustment
Medical Episode GrouperCardiac arrhythmias• Population profiling
• Provider profiling
>500AllNoDisease 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.

June 14, 2020

Measuring morbidity vs. measuring episodes: Two parallel views

Clinical risk groups and patient complexity: a case study with a primary care clinic in Alberta

In order to assess the health risk of a population there are two main options: Morbidity adjustment and Episodes of care. The first one can use Clinical Risk Groups, while the latter Patient focused episodes. The morbidity adjustment is useful for adjusting at population level, it is a categorical system, while episode measurement adjusts at patient level .
In this article you'll find an interesting application to a primary care center.
CRGs have definite value with respect to predicting health care utilization, but it is important to note the limitations of the CRG as a stand-alone classification of complexity, particularly for the categorization of patients in the health status 1 through
5 categories. In order to enhance the accuracy, relevance and predictive value of the CRG classification methodology, we see great value in pursuing methods that allow for the careful and systematic inclusion of information from the care record.
The article is trying to use the CRGs for episode measurement, and this is a wrong approach. CRGs are useful as a whole picture, physicians need details, only episodes can provide such information.


February 20, 2013

Patient focused episodes

We all know that no measurement means no management. In health care the measurement of the burden of disease is not that easy. Fortunately at a global level there is the recent study published at Lancet and quoted in this post. If we need to be precise in the measurement with consequences for health care management then we need better tools. Diseases finally appear around episodes, and we may have three type of episodes: event based, disease cohort and population based. The definition of episode needs to be patient-focused rather than disease centered. If you want to know the details of the newest approach to morbidity measurement have a look at this document. It is the evolution of former Clinical Risk Groups towards a new model that will be extremely helpful for management decision making and the definition of appropriate incentives.

PS. Some months ago I explained that new payment systems were in train of being defined. An impact analysis may be found here. My post was titled: A retrofuturist payment system. Now, I would like to change the title once I've seen the details, my proposal is: A complete MESS that needs to be rebuilt from scratch. (to be continued)

PS. Yesterday I attended a book presentation: "I am not Sidney Poitier", by Percival Everett. It was at La Central bookstore. Percival explained the rationale of the book and its subliminal messages.  This is not the kind of novel I'll read.