HCI3 Releases Episode Analysis Freeware to Assist CMS Bundled Payments for Care Improvement Applicants

Software part of free online tools and resources to help providers and other applicants apply for the pilot

WASHINGTON, Oct. 13, 2011 /PRNewswire/ -- To support providers and other applicants to the Center for Medicare & Medicaid Innovation's (CMMI) Bundled Payments for Care Improvement initiative, the not-for-profit Health Care Incentives Improvement Institute (HCI3) released a new version of its episode of care analysis freeware. The goal of the CMMI pilot is to improve patient care through payment innovation that fosters improved coordination and quality through a patient-centered approach.

"This special version of our free episode analysis software will enable hospitals and physicians to not only estimate the episode price for the Bundled Payment pilot, but also provide them with valuable insights on their current potentially avoidable complications," said Francois de Brantes, executive director for HCI3, an organization devoted to improving health care quality by creating and implementing programs that deliver positive financial incentives for providers that deliver high value care. "The end result is an actionable roadmap for improving the quality of care delivered and lowering historical episode costs."

The CMMI Bundled Payment ECR^® (Evidence-Informed Case Rates^®) freeware is customized to run on Medicare Part A and B claims and help potential pilot applicants analyze the cost of different episodes, including Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), Total Hip Replacement, Total Knee Replacement, Coronary Artery Bypass Graft (CABG), Percutaneous Coronary Interventions, Pneumonia, and Acute Myocardial Infarction (AMI). Users can select specific hospital stays to include in the analysis and modify the episode time window post discharge. The analysis will also generate frequencies and costs of National Quality Forum-endorsed potentially avoidable complications associated to these episodes, including preventable readmissions.

In addition to this special version of its freeware, HCI3 has dedicated a section on its website to the CMMI pilot and posted a number of downloadable resources including an overview of the types of organizations well suited to apply for pilot status and case studies that explain how contractual agreements can be arrived at between hospitals and physicians to make bundled payments work.

HCI3 will also release benchmark episode prices based on its analysis of Medicare data to help potential pilot applicants compare their results and estimate their episode prices.

PROMETHEUS Payment^® ECRs^®

The PROMETHEUS Payment^® Evidence-Informed Case Rates^®, or ECRs^®, are patient-specific, severity-adjusted bundles of services during a defined time period for the treatment of specific conditions. The PROMETHEUS ECR analytics can be used to assist prospective CMMI Bundled Payment Pilot sites in selecting their episode of choice and creating a bundled episode price for each one selected.

Bundled Payments for Care Improvement

The Affordable Care Act provides a number of new tools and resources to help improve health care and lower costs for all Americans. CMS is working in partnership with providers to develop models of bundling payments through the Bundled Payments for Care Improvement initiative. Bundling payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement, is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. Such initiatives can help improve health, improve the quality of care and lower costs.

The Bundled Payments initiative is seeking applications for four broadly defined models of care, three of which would involve a retrospective bundled payment arrangement, with a target price (target payment amount) for a defined episode of care.

About Health Care Incentives Improvement Institute™, Inc.

The Health Care Incentives Improvement Institute, Inc. (HCI3^®) is a not-for-profit multi-stakeholder umbrella organization for Bridges to Excellence^® and PROMETHEUS Payment^®. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. health care system. www.HCI3.org

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Francois de Brantes

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SOURCE Health Care Incentives Improvement Institute (HCI3)