Project Summary: Evaluate Cost of Care to Move Towards Value-Based Economic Model
Category: Payment Reform
Background: This healthcare provider seeks to move from a volume based economic model to a more value based model based on cost containment, quality outcomes and patient satisfaction. Currently, this provider is able to receive independent verification of quality outcomes and patient satisfaction, but is unable to obtain cost structure information.
Objective: Independently verify cost structures within market parameters and help hospital systems move to a more value-based economic model based on cost containment, quality outcomes, and patient satisfaction.
Data Analyzed: Median charges, median allowed amounts, median plan paid, median member paid for the top 25 DRGs by utilization by hospital referral region.
Results: The health care provider was able to determine that the data in the CO APCD was accurate when compared with their internal data. A few service lines (knees and shoulders) were found to be a higher cost than expected which allowed the health care provider to examine ways to make their services more competitive in the interest of patient satisfaction.