SYSTEM AND METHOD FOR CREATION OF EVIDENCE-INFORMED CASE RATE BUDGETS FOR BUNDLED PAYMENTS
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Aug 17, 2016
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Aug 17, 2015
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The invention provides a computer implemented method for constructing a patient-specific evidence-informed case rate (ECR) for an episode of medical care spanning a defined period of time for a particular payer-provider-patient triad to create a patient-specific, severity adjusted prospective budget for the patient. ECR Analytics is a tool that constructs episodes of care using administrative claims data, both medical and pharmacy. It calculates the cost of care of patient-specific episodes by assigning relevant services to each episode and further distinguishing those services as typical or routine versus those associated with a complication. The episodes calculated within ECR Analytics can be attributed to specific providers, risk adjusted for performance measurement, and can also be used to construct prospective budgets for payment purposes, such as episode of care payment or reference pricing.
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