By: Neha Thomas Jun. 09, 2020
Dexur analyzes Medicare Claims data to evaluate the value outcomes of hospitals and post-acute care organizations. Value outcomes analyze total cost over a 90-day period from the date of index hospitalization. ACOs & Payors benefit from this data to help manage overall population health. Patients benefit from this data as they can make informed choices regarding the facilities that will provide them the best care for specific conditions with the best value.
Value Outcomes closely align with the triple aim objective of better value, better care, and better health. Value outcomes are also closely aligned to bundled payment initiatives by CMS and other payors. Bundled payments are classified under alternative payment models that incentivize providers to promote efficiency and coordination of care along with improving quality outcomes at lower costs. The total acute and post-acute costs are predetermined in case of bundled payments. The losses or savings are shared by participant providers that result from the difference between the target price and actual costs.
Value outcomes depend on the different costs that constitute the total average cost of care namely, index hospitalization costs, post-acute care costs, rehospitalization costs, and ED costs. The start of the 90-day episode is from the date of initial index hospitalization.
| Cost of Care Components | Description |
|---|---|
| Index Hospitalization | Cost associated with Index hospitalization |
| First interaction nursing home cost | Cost incurred at the first nursing home visited post discharge from the hospital where index hospitalization happened |
| Other interaction nursing home cost | Cost incurred at other nursing homes post discharge from the first interaction nursing home |
| First interaction home health agency cost | Cost incurred at the first home health agency visited post-discharge from the hospital where index hospitalization happened |
| Other interaction home health agency cost | Cost incurred at other home health agencies post discharge from the first interaction HHA |
| Rehospitalization costs | Cost incurred due to re-hospitalization post initial discharge |
| ED cost | Cost incurred for care at any Emergency Department post discharge from the hospital where index hospitalization happened |
Dexur value outcomes analyses are risk-adjusted and are done at the DRG level in order to adjust for complications and comorbidities. Moreover, value outcomes can be done at two levels: (i) for all patients (including those who have died during the course of an episode) and (ii) patients who are alive and have not had a hospice interaction.
Post-acute care providers play a critical role in managing overall value outcomes for hospitals since a significant portion of the care happens after hospital discharge. Here are are the cost and quality outcomes that Post Acute Care facilities can help manage:
| Cost / Service | How Post Acute Care Can Help |
|---|---|
| First interaction nursing home or home health costs | Lower average first interaction nursing home or home health costs results in better value outcomes. |
| Other subsequent interaction nursing home / home health agency costs | Lower average other interaction nursing home / home health cost results in better value outcomes. Better quality care at the initial nursing home or home health can also help reduce other subsequent nursing home / home health interactions, rehospitalization costs, and ED costs. |
| Rehospitalization costs | Better quality at the initial interaction lowers chances of hospital readmission and drives better value outcomes. Lower rehospitalizations cost indicates results in value outcomes. Lower rehospitalizations cost results in better value outcomes. |
| ED cost | Better quality at the initial interaction lowers chances of ED visits and drives better value outcomes |