Use Cases
Historically, and with very few exceptions, episode groupers have been used to measure the relative efficiency of providers. PACES was developed to accomplish much more, powering risk-based contracts, creating valid and standard peer-to-peer comparisons, improving the efficiency of ACOs, helping purchasers optimize their care purchasing by optimizing networks, and much more. Here are some of these use cases.
Cost And Outcomes (ACOs; Health Systems, Payers, Data Analytic/Consulting Firms)
PACES gives users the depth of visibility and the ability to compare outcomes across providers, whether they are in or out of network. Because conditions and procedures can be linked through episode associations, users can also better determine the appropriateness of care.
Optimizing financial and clinical outcomes for all the care of an attributed plan member or beneficiary requires a deep understanding of the effectiveness and efficiency of the care delivered for each of the conditions and procedures that occurred during a performance period.
Performance Report Card (Provider Organization, Payers, Data Analytic/ Consulting Firms)
Outputs from PACES aren't reduced to an index that compares a provider managing an episode against an average. Rather, PACES generates a forensic view of all the claims that were assigned to each episode, the price paid for each service (which can be compared to the facility or practice's costs of delivering the service) and the number and sequence of those services.
Comparing the results of each episode, while adjusting for patient case mix, can reveal the sources of controllable variation that explain the performance of a provider in the management of a condition or procedure relative to their peers. This makes report cards actionable and credible.
Clinical Decision Support tools (Clinicians)
A physician in a practice, or even an entire practice, often has only a limited view into a patient's total care, even if that care is for a specific condition managed by the physician, because some care is often provided by others. In fact, clinicians typically contribute less than 15% of the total price paid across all services associated with the management of a condition or procedure.
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PACES gives clinicians a 360 degree view of all the care that was provided and the prices paid for that care. This gives clinicians an unparalleled view into how to improve outcomes, increase appropriateness of care and reduce potentially avoidable complications.
Powering AAPMs
Advanced Alternative Payment Models (AAPMS) are payment models in which the financial risk associated with the care of patients is shared between the purchaser and the provider. Today, health care purchasers and payers have defaulted to payment models holding total costs of care at risk because they have lacked the tools to design and administer more nuanced and sophisticated models, such as those for specialty care.
PACES was designed to solve that problem, by having a large standard set of episodes that cover all the conditions and procedures that are typically managed by a specific specialty. Purchasers can use PACES to set benchmarks for each episode within a specialty area, and then aggregate those benchmarks into a global payment for specialty care. Importantly, both the purchaser and the provider can then track the results by episode and across episodes within a chapter to measure and improve performance.
