FAIR Health to Create Cost Estimates for Complete Episodes of Care

Aug 06, 2015, 10:45 ET from FAIR Health

NEW YORK, Aug. 6, 2015 /PRNewswire-USNewswire/ -- FAIR Health announced today its collaboration with the Health Care Incentives Improvement Institute (HCI3) to develop healthcare cost data for complete episodes of care.  The goal of the initiative is to make available to healthcare consumers, researchers, providers, payers and others the ability to estimate likely expenses for all procedures associated with common illnesses or conditions, thereby facilitating better planning, budgeting, and self-care management.

FAIR Health has licensed HCI3's proprietary software that will enable the company to work with the HCI3 Evidence-Informed Case Rate (ECR®) definitions, also known as episodes of care.  FAIR Health will run its healthcare claims data through the ECR Analytics® system to relate costs of treatments, procedures, and frequencies of services associated with differing risk profiles to generate an overall combined estimated out-of-network cost for each of 96 chronic conditions, illnesses and surgeries.  FAIR Health will collaborate with HCI3 to evaluate the results and then publish the ECR budgets in formats appropriate for each of its stakeholder audiences.  A primary goal for FAIR Health is to add episode-of-care cost information to the user-friendly cost transparency tools available through its award-winning consumer website, available in English (www.fairhealthconsumer.org) and Spanish (www.consumidor.fairhealth.org).

Applying FAIR Health's massive data repository to HCI3's ECR Analytics® can provide a comprehensive estimate of costs associated with chronic illnesses such as diabetes and heart disease, as well as more acute conditions such as knee replacement surgery.  The cost estimates developed for episodes of care will cover the full range of practitioner services, facility use and medical devices associated with each of the 96 ECRs.  Understanding the complete cost of care can help consumers better plan their healthcare expenses, and also can assist policymaking, best practices and public health initiatives.

Francois de Brantes, HCI3's Executive Director, noted "Infusing FAIR Health's vast claims data into our state-of-the-art analytics will significantly advance the effort to simplify healthcare payment and to inform quality and value-based measures that ultimately benefit consumers, providers, plans, and employers."

"Making this type of information public will improve understanding of overall healthcare costs," said Robin Gelburd, President of FAIR Health. "Identifying for the first time the broad range of services associated with a surgery, illness or condition will enable sound decision-making and planning by patients and their families." 

FAIR Health is a national, independent, nonprofit corporation dedicated to bringing transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and health systems research support.  FAIR Health uses its database of billions of privately billed medical and dental services to power an award-winning, free website that enables healthcare consumers to estimate the cost of medical and dental care.

Health Care Incentives Improvement Institute, Inc. is a nonprofit organization that aims to create significant improvements in the quality and affordability of health care through evidence-based incentive programs and support of payment reform models.  It is the umbrella organization for the Bridges to Excellence® program and PROMETHEUS Payment® model, as well as the creator of episode of care, or Evidence-informed Case Rate (ECR®), definitions and the ECR Analytics® system. Through these components, HCI3 offers a comprehensive package of solutions to employers, health plans, health systems and coalitions.