Accelerating and Aligning Clinical Episode Payment Models

Report: Released August 1, 2016

Description

The CEP Work Group conducted research on a range of existing episode payment initiatives. After analyzing the findings of that research, the Work Group identified a set of 10 episode payment model design elements. These elements, outlined in this chapter, reflect the decisions that payers and providers need to make prior to implementation.

Authors

Clinical Episode Payment (CEP) Work Group of the Health Care Payment Learning & Action Network

Publication Info

Publication date: August 1, 2016
12-14 pages

Suggested Citation: Health Care Payment Learning & Action Network. Accelerating and Aligning Clinical Episode Payment Models.
August 1, 2016.

Clinical episode payment models are different from traditional FFS health care payment models in which providers are paid separately for each service they deliver. Instead, clinical episode payment models take into consideration the quality, costs, and outcomes for a patient-centered course of care over a set period of time and across multiple settings. This course of care is known as the clinical episode. Research suggests that when payments for health care are based on the care delivered in a clinical episode, the result is increased coordination of care, enhanced quality of care, and less fragmentation in the medical system. This leads to better experience and health for patients and lower costs for payers and providers.

Elective Joint Replacement

Maternity Care

Coronary Artery Disease

Operational Considerations

Briefing Deck – Clinical Episode Payment Model

Figure 3: Episode Payment Design Elements and Operational Considerations

CEP-Figure-3

Coming soon!

Webinars

February 2016 Webinar: LAN Update – Accelerating and Aligning Clinical Episode Payment Models: Preliminary Recommendations on Elective Joint Replacement (archive)

March 2016 Webinar: LAN Update – Episode Bundles: Why It Matters and What Purchasers Can Do Now (archive)

March 2016 Webinar: LAN Listening Session for States – Preliminary Recommendations on Elective Joint Replacement (archive)

March 2016 Webinar: LAN Listening Session for Payers – Preliminary Recommendations on Elective Joint Replacement (archive)

March 2016 Webinar: LAN Listening Session for Providers – Preliminary Recommendations on Elective Joint Replacement (archive)

April 2016 Webinar: LAN Summit Session – When APMs Intersect: The Challenges and Opportunities of Implementing Episode Payment in a Population-Based Payment Environment (archive)

April 2016 Webinar: LAN Summit Session – Improving the Delivery of Cardiac Care Via Episode Payment Opportunities and Challenges (archive)

April 2016 Webinar: LAN Summit Session – Improving the Delivery of Maternity Care Via Episode Payment Opportunities and Challenges (archive)

May 2016 Webinar: LAN Listening Session – Opportunities & Challenges in Maternity Care Episode Payments (archive)

June 2016 Webinar: LAN Listening Session – Opportunities & Challenges in Cardiac Care Episode Payments (archive)

Blogs

Lowering Costs and Improving Care Through Episode/Bundled Payments
by Lewis Sandy, MD, MBA

 

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