Solutions Episodes of Care

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Episodes of Care Benchmarks

Offering market-level, geographically specific data for the full range of procedures associated with beginning-to-end treatment for common illnesses, chronic conditions and surgeries—and adjusting patient profiles to reflect comorbidities and risk factors—this product provides a clear view of today’s per-episode healthcare costs by local market area.

Episode Benchmarks Adjusted for Comorbidities and Risk Factors

How does your claims experience, seen through an episodes-of-care lens, compare to that of other organizations? Providing a comprehensive view of actual healthcare costs in geographically specific markets across the country, FH Episodes of Care Benchmarks offers benchmark charge and allowed amounts for the full range of procedures and services related to common illnesses, conditions and surgeries—including professional and facility fees as well as procedures, devices and equipment billed through HCPCS codes. Users can adjust base episode costs to include patient comorbidities and risk factors.

Providing essential insights into value-based reimbursement and related pricing studies, provider budgeting, network building and more, FH Episodes of Care Benchmarks includes:

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  • Procedures and associated frequencies that compose the patient’s beginning-to-end treatment path for more than 40 episodes, from asthma care to heart surgery;
  • Ability to choose both the episode and the code for the procedure (referred to as the “trigger” code) that defines the episode;
  • Application of up to five common comorbidities and five risk factors per episode to refine costs based on the patient’s profile;
  • Allowed amount and billed charge benchmarks at the 50th and 80th percentiles;
  • Benchmarks by local market area for each of 493 geozips;
  • Pricing for the overall episode plus detail showing costs and quantities for each individual procedure; and
  • Ability to customize each episode based on business needs, treatment protocols and/or plan design.

When used in conjunction with FH Episodes of Care Analytics, FH Episodes of Care Benchmarks enables comparison of an organization’s own experience to episode costs for competitors by local market area.

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