How Episodes of Care Improve Value-Based Reimbursement

In value-based reimbursement models, using an episode-based approach to performance measurement links services provided by different providers in different settings. However, widespread confusion about how episodes of care (EOC) are defined presents a challenge to practical applications. Value-based contracting is spurring complicated discussions on determining lump-sum payments, quality metrics to be used for bonuses or penalties, and arrangements for how shared savings should be split.

In this IDC Analyst Connection article, Jeff Rivkin, research director of Payer IT Strategies at IDC Health Insights, discusses EOC definitions and explains the Health Care Incentives Improvement Institute’s PROMETHEUS (Provider Payment Reform for Outcomes, Margins, Evidence, Transparency, Hassle-Reduction, Excellence, Understandability, and Sustainability) initiative.

Read the article for tips and advice on how payers evolving from fee-for-service models or expanding their fee-for-value programs to scale across multiple health systems can best implement value-based reimbursement.