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


We held discussions with eight experts to explore issues related to constructing and using episodes of care for the purposes of performance measurement and to better align financial incentives to deliver high quality, efficient and coordinated care across an episode of illness or injury. - Because this area of work is largely in a conceptual state of development, experts were viewed as a key resource for investigating the policy issues of interest, absent published work in this area. The experts were individuals who had experience in one or more of the following areas: 1) constructing episodes of care; 2) using episodes of care for either performance measurement or payment; 3) issues of attribution and case mix adjustment; 4) provision of medical care.

Our discussions with the experts focused on the following topics:

  1. Approaches to payment and performance measurement that create incentives, both financial and non-financial, within an episode of care, to drive performance improvement and efficiency;
  2. How to define an episode of care, including, but not limited to our three approaches (single setting, multiple types of providers in a single setting, and then across the continuum of Medicare settings), and whether certain clinical conditions more and less suitable for an episodes-based approaches;
  3. Attribution issues related to shared versus individual accountability for an episode of care;
  4. Use of risk-adjustment within episodes of care.

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