For each person utilizing services, total claim payments i. Reports identified the average and total cost for the condition within the customers population. The ibm cost of care model uses administrativecommercial claims to help predict healthcareresource. Mar 29, 2019 to conduct a costofillness analysis using an episode grouper, a likely first consideration is which grouper has a relevant episode definition. The truven health medical episode grouper meg is the proprietary episode grouping methodology of truven health analytics. Summing this field over all related service lines for a given episode will yield a result. Symmetry procedure episode groups peg provide a valid clinical measure of cost and quality related to medical and surgical procedures. The aggregate dollar amount of claims payment constitutes the cost of an episode. Episode treatment groups how is episode treatment groups. Episodes include all services involved in diagnosing, treat. The episode groupers build episodes of care using all of a beneiciarys health care claims that are iled between two points in time for a speciic health problem. Appendix c clinical classification systems grouper. To understand how to apply the grouper software to va data, we first tested it on 2 patients with a diagnosis of diabetes in fy05.
Episode groups peg, prometheus, and medical episode grouper meg. Medical episode grouper meg can be used within plan analytics to analyze condition prevalence, cost, and utilization patterns across a population by grouping all of the care for a single medical condition for one patient. Need for risk adjustment in adapting episode grouping. Pdf despite the prominence of episode groupers for analysis and reimbursement in us payer.
Episodes of care provide a useful unit of analysis for evaluating healthcare utilization and cost. Episodes of care episodes of care are constructed by using the medical episode grouper meg. Specializing in medical episode grouper meg skilled in integrated analytics measuring corporate strategies within the health plan market. Identify forecast revenues at the time of booking patient appointments. Meg allows for the analysis of a particular patients complete episode of care for a single illness or condition. To measure cost efficiency, carefirst uses 5watson healths medical episode grouper meg software for identifying medical episodes of care and optums procedural episode group 6 peg 7 software for procedural episodes of care. The medical episode grouper assigns each claim to one of 570 episode types based on primary and secondary diagnosis rather than procedure codes. The medical episode grouper meg is the proprietary episode grouping methodology of truven health analytics, now ibm watson. Although this is the largest p4p program in the nation, it amounts to less than 2% of california physicians income. Need for risk adjustment in adapting episode grouping software to medicare data. Evaluating the functionality of the symmetry etg and. Provider payment arrangements, provider risk, and their relationship with the cost of health care caveat and disclaimer the opinions expressed and conclusions reached by the authors are their own and do not represent any official position or opinion of the society of actuaries or its members. In total, there are over 500 episode categories that.
Using claims data to predict healthcare resource consumption. The medical episode grouper meg is the proprietary episode grouping methodology of ibm watson. Revenue cycle management supported with the ability to. To conduct a costofillness analysis using an episode grouper, a likely first consideration is which grouper has a relevant episode definition. A practical guide to episode groupers for costofillness. Bundled payment solution episode management change healthcare. Despite the prominence of episode groupers for analysis and. The software also analyzes actual costs and determines expected resource use during an episode. Pdf a practical guide to episode groupers for costof.
Meg is a proprietary grouping algorithm that creates episodes that describe a patients complete course of care for a single illness or condition. Truven health analytics study identifies leading drivers of. Comparemaine is now live see the new site at the soft launch was october 1, 2015 and on october 27. Episode treatment groups etgs by symmetry and medical episode groups megs by thomsonreuters medstat. Each persons health insurance claims were attributed to specific diseases using the truven health medical episode grouper meg, which includes an expansive classification of 560 conditions. Key portions of the episode grouper are based on our disease staging methodology. If requesting episodes of care file, no other data file is needed. Measurement of and reward for efficiency in californias.
An episode grouper is a set of software programming algorithms that systematically define the healthcare services that belong to multiple distinct healthcare episodes. The medical episode grouper meg is the proprietary episode grouping methodology of truven health analytics, now ibm watson health. Under this collaboration, output from the medical episode grouper meg, developed by thomson reuters, would be integrated into careevolutions clinical cockpit to deliver comprehensive patient medical histories of all medications and treatments. Medical episode grouper meg can be used within plan analytics to analyze condition prevalence, cost, and utilization patterns across a population by grouping all of the care for a single medical. Evaluating the functionality of the symmetry etg and medstat. To conduct a costofillness analysis using an episode. Jul 23, 20 each persons health insurance claims were attributed to specific diseases using the truven health medical episode grouper meg, which includes an expansive classification of 560 conditions. Meg is a methodology that links inpatient, outpatient, and prescription experience into clinically relevant episodes of care. User guide provider engagement solution watson health. Allow episode analysts to compare program definitions to actual claim data and to recognize trends with summary and detail reports.
Using multipayer data from the marketscan commercial database, we applied the two most widely used commercial episode groupers. Software applications referred to as groupers sort through claims data and group individual feeforservice claims into an episode of medical care. Panda matches patients to other patients with the same clinical condition using meg s episodes of care. Evaluating the functionality of the symmetry etg and medstat meg software in forming episodes of care.
Medical episode grouper meg an episode is all care for a course of treatment of a disease primary and secondary diagnosis codes grouped into one of 560 disease categories stratified by severity of illness disease categories and clinical criteria specified by physicians at jefferson medical college. Symmetry and medical episode groups megs by thomsonreuters medstat. Physician efficiency, appropriateness, and quality peaq. What are the leading drivers of employer healthcare spending. Meg was developed by truven health then medstat in the early 1990s and first. Pdf a practical guide to episode groupers for costofillness. What are the leading drivers of employer healthcare. Episodes can be comprised of professional and facility inpatient and outpatient services, as well as prescription drugs. Truven health analytics study identifies leading drivers. We used the medical episode grouper meg by truven analytics, to determine the grouping of claims and the median cost for these 10 surgical procedures. Final 2009 criteria for practitioner profile 081109 mc. A better unit of analysis than either of these extremes is an episode of care that crosses care settings and includes a prepost period of time relevant to the specific condition or medical event, such as a hospital stay and postacute care for 30 days after discharge, or. Episodes of care the milliman healthcare analytics blog.
Comparing commercial systems for characterizing episodes of care. We then applied the groupers to patients from each diagnostic cohort using fy05 data and compared meg and etg output with respect to several episode criteria by condition. Whether you seek to reduce the variability of care across a large health system, or you simply want to bring precision medicine to your community practice, ibm watson health is ready to work with you. Business health care industry health care costs management medical care quality management medical care quality medical care, cost of medical practice software usage prospective payment systems medical care.
The groupers varied in their ability to allocate spending to episodes. What is the abbreviation for medical episode grouper. At a very high level, one can think about these algorithms as assigning each of. The cost efficiency methodology uses thomson reuters medical episode grouper meg. As of january 2019, cmsbpci had the fewest defined episodes n 48, while 3m pfe, optuminsight symmetry etg, cave grouper, and meg all n 500 had the most table 2. New tables to support truven input specification, truven medical episode grouper meg, truven outpatient event grouper opeg, relative risk score, cost of care, disease staging, and service category.
Etg and medical episode grouper meg groupers, two leading commercial episode products. The episode completeness and outlier flags allow users to include, or exclude, types of episodes to further refine their analysis. Today, more than 150 health plans, employers and state medicaid. The medical episode grouper meg is the proprietary episode grouping methodology. Thomson medstat medical episode grouper system aspe. Measurementofandreward forefficiencyincalifornias payfor. In addition, meg can allot up to 4 disease stages to a base meg episode, with stage 1 representing the lowest level of health complication and stage 4 being death. Comparing commercial systems for characterizing episodes. Bundled payment solution episode management change. A better unit of analysis than either of these extremes is an episode of care that crosses care settings and includes a prepost period of time relevant to the specific condition or medical event, such as a hospital stay and postacute care for 30 days after discharge, or the care of a patients chronic condition for a year.
To examine the feasibility of applying two commercially available egs, medstats medical episode grouper meg and ingenixsymmetry episode treatment groups etgs to va data, and to compare them with respect to their ability to group claims data representing an episode of care for each of four chronic medical conditions. Comparing commercial systems for characterizing episodes of care comparing commercial systems for characterizing episodes of care much attention has been paid to the effects of different rules for assigning episodes to providers, but little to how individual costs are assigned to episodes. The thomson medstata medical episode grouper meg is a grouping system that creates clinically homogenous and meaningful units episodes for analysis using inpatient, outpatient and pharmaceutical claims data. Denise culkowski methodologist truven health analytics. It is diagnosisdriven and includes an exhaustive classification of 572 conditions. Medical episode group meg is a vendor proprietary grouping algorithm that creates episodes of care that describe a patients complete course of care for a single illness or condition medical episode grouper meg episode description medical episode grouper meg unique identifier for a single episode. Episode groupers are proprietary software programs that organize claims data into a set of clinically coherent episodes, usually linked by diagnosis. Similarly, etg episodes for otitis media include claims for conditions related to eustachian tubes, while the meg grouper puts these into other ear, nose and throat disorders. Using medical groups rather than individual physicians has a number of advantages. Today, over 150 health plans, employers, and state medicaid agencies use meg. At a very high level, one can think about these algorithms as assigning each of a patients medical claims to a particular episode.
Meg was developed by truven health then medstat in the early 1990s and first released commercially in 1998. Each admission, claim, and encounter record is assigned a disease category and. Medical episode grouper meg can be used within plan analytics to analyze condition prevalence, cost, and utilization patterns across a population by. These algorithms rely on the medical expertise incorporated into the programs. Episode groupers healthcare transformation task force. Understand the cost and quality of medical procedures. Evaluating the functionality of the symmetry etg and medstat meg.
Help adjudicate claims quickly and accurately to all the providers included in the episode of care. Episodes of care file contains all medical claims, all pharmacy claims, and fields from the medical episode grouper meg. Truven health medical episode grouper semantic scholar. The thomson medstata medical episode grouper meg is a grouping system that creates clinically homogenous and meaningful units. Using predictive models to move medicaid providers toward. Plan analytics medical episode grouper meg allow customers to identify records in a population identifying patients with a specific medical condition, such as refluxrelated hernia. Provider payment arrangements, provider risk, and their. Meg abbreviation stands for medical episode grouper. Coinsurance is the percentage of medical bill the member shares with the health plan after they have paid the deductible. Defined by truvens medical episode grouper meg agenda item 8. Etgs is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms. Clinician feedback on using episode groupers with medicare. Medecision introduces alineo care management analytics.
Measurementofandreward forefficiencyincalifornias pay. Etg and medical episode grouper meg groupers, two leading. Meg incorporates demographic and diagnosis data from claims to link inpatient, outpatient, and pharmacy services into diseaserelated episodes of care and classifies the severity of disease within an episode. Get a clear and consistent view of key performance metrics associated with episodes from visual dashboards. Carefirst members are attributed to the pcmh pcp they choose or, if they. Feb, 2018 agenda item 8 pension and health benefits committee page 2 of 5 table 1. Acute, chronic and well care medical episode grouper meg prorated episode allowed amount allocation for the given service line. User guide provider engagement solution watson health version 5. This field allows a user to sum detail lines for an overall episode count. Need for risk adjustment in adapting episode grouping software to. Thomson reuters and careevolution collaborate to empower. Ingenix symmetrys episode treatment groups etg and the thomson reuters medical episode grouper meg. Comparing commercial systems for characterizing episodes of. Each persons health insurance claims were attributed to specific diseases using the truven health medical episode grouper meg.
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