Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. 4. Literature Review and Expert Discussions


In this chapter, we summarize our findings from a systematic review of the literature on the use and proposed use of episode-based approaches to payment, performance measurement, and accountability.  We also present the results from our discussions with a small set of experts, where we explored issues related to constructing and using episodes of care for the purposes of performance measurement and accountability to better align financial and non-financial incentives to deliver high quality, efficient and coordinated care across an episode of illness or injury.

We organized our review and discussions around four questions:

  1. How have payment and performance measurement been applied using episodes of care as a basis for payment and performance measurement?
  2. What types of episode constructions have been used or proposed for use in the context of payment and/or performance measurement?
  3. How can accountability for episodes be assigned when multiple providers and settings are involved?
  4. How has risk adjustment of episodes of care been performed or proposed?

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