Life Sciences

Are you ready to take advantage of the shift towards value-based reimbursement?  Use PurpleLab’s Agile Provider Profiling Platform™ to compare your provider customer’s performances to other providers in competitive markets.

Specifically, you can use our platform to apply standard objective provider performance measures (e.g., outcomes and costs) to an unlimited number of conditions or procedures to understand how providers rank against their local, regional and national peers.  This level of insight gives you a sense into future shifts in patient flows in the era of public reporting in the name of transparency, pay-for-performance, and value-based reimbursement policies.

Using our platform, you can apply standard outcomes measures to any off-the-shelf or custom clinical condition or procedure, including any or all 48 of the CMS Bundled Payments for Care Improvement (BPCI)). These abilities enable you to see which providers will struggle to survive versus which providers will thrive under bundled payment initiatives.

Why do you care? Ultimately, risk shifting will lead to shifts in payer network design and development.  Risk shifting will lead to winners and losers among providers.  Providers who offer the right performance histories related to Experiences, Outcomes, Appropriateness and Costs will get in-network contracts and those that don’t will get left behind.  Ultimately, shifts in risk will lead to shifts in patient flows from one provider to another provider with better performance history.

Knowing ahead of time, which providers will survive and thrive under bundled payment strategies, should inform and drive your account-based sales and contracting strategies.  Ultimately, value-based reimbursement affects contracting, patient volumes which will impact market access decisions.  Why? Because a provider with insufficient experience (volumes of patients and cases) may not have predictable outcomes or costs that are in line with where they need to be under bundled payment reimbursement models. That provider has to get better at operations or get out of that line of business.  You need to know now who the winners and losers are going to be.  Our Agile Provider Profiling Platform™ lets you evaluate the census of the nation’s healthcare providers based on their historical performance on a relative, peer-to-peer basis.

We know who the winners and losers will be because we can see from many years of data, how they have performed in the past and we can forecast how they will perform in the future.

Standardized Measures Include: Measures of unplanned outcomes, including preventable mortality, complications and excess days in acute care.

  • Mortality Measures
    • In Hospital Mortality
    • Post-Discharge Mortality (e.g., 30, 60, 90 days)
  • Complication/Adverse Event Measures
    • Direct Measures of Complications
      • Potentially Preventable Adverse Events (PPAE)
        • Peri-Procedural Adverse Events
          • Major Peri-Operative Adverse Events
            • Extreme CNS Complications
            • Stroke & Intracranial Hemorrhage
            • Acute Pulmonary Edema and Respiratory Failure
            • Ventricular Fibrillation/Cardiac Arrest
            • Shock
          • Significant Peri-Operative Procedural Adverse Events
            • Foreign Body Reaction
            • Inappropriate Procedure
            • Accidental Puncture or Laceration
            • Hemorrhage & Hematoma
            • Complications Related To Device, Implant or Graft
            • Complications Related To Gastrointestinal Ostomy
            • Complications of Genitourinary Surgery & Other Genitourinary Complications Except UTI
            • Acute Pulmonary Edema and Respiratory Failure
            • Iatrogenic Pneumothorax
            • Pulmonary Embolism
            • Other Pulmonary Complications
            • Peripheral Vascular Complications Except Venous Thrombosis
            • Venous Thrombosis
            • Acute Myocardial Infarction
            • Other Cardiac Complications
            • Other Moderate Post-Procedural Complications
          • Significant Peri-Operative Medical Adverse Events
            • Complications Related To Transfusion Incompatibility Reaction
            • Complications Related To Anesthesia
            • Complications Related To Non-Anesthesia Medications
            • Major Liver Complications
            • Renal Failure
            • Cellulitis
            • Moderate Infections
            • Encephalopathy
            • Hypotension
      • Post-Procedural Adverse Events
        • Significant Post-Operative Procedural Adverse Events
          • Central Line-Associated Blood Stream Infections (CLABSI)
          • Catheter-Related Urinary Tract Infections (CAUTI)
          • Surgical Site Infections (SSI)
          • Reopening Or Revision Of Surgical Site
          • Major Gastrointestinal Complications
        • Significant Post-Operative Medical Adverse Events
          • Clostridium Difficile Infections
          • Pneumonia & Other Lung Infections
          • Infection, Inflammation and Clotting Complications of Peripheral Vascular Catheters and Infusions
          • Other Infections Including Urinary Tract Infections
          • In-Hospital Trauma and Factures
          • Complications Related To Non-Anesthesia Medications
          • Acute Mental State Changes
          • Post-Hemorrhagic & Other Acute Anemia
          • Major Liver Complications
          • Renal Failure
          • Pressure Wound Ulcer
          • Other In-Hospital Adverse Events
          • Other Complications Of Medical Care
      • Healthcare-Associated Infections (HAIs)
        • Catheter-Associated Urinary Tract Infection (CAUTI)
        • Central Line-Associated Blood Stream Infections (CLABSI)
        • Surgical Site Infections
        • Pneumonia-Associated Infections
        • Pathogen-Associated Infections
      • Hospital Acquired Complications (HAC)
        • Foreign Object Retained After Surgery
        • Air Embolism
        • Blood Incompatibility
        • Stage III and IV Pressure Ulcers
        • Falls and Trauma
        • Manifestations of Poor Glycemic Control
        • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Certain Orthopedic Procedures
        • Iatrogenic Pneumothorax with Venous Catheterization
      • Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI’s)
        • Inpatient Safety Indicators (IQIs)
        • Patient Safety Indicators (PSIs)
        • Prevention Quality Indicators (PQIs)
    • Indirect Measures of Complications
      • Prolonged Length of Stay (prLOS)
  • Excess Acute Care Day Measures
    • Readmissions
      • Total Readmissions
      • Unplanned Readmissions
    • Observation Days
    • Emergency Room Visits
Conditions and Procedures Include: any and all of the individual ICD9/ICD10 diagnosis or procedure code as well as all of the individual CPT/HCPCS codes.  Individual codes organized into “clinical groupers” or “code groups” make it easier to analyze patterns of diagnoses and procedures in order to understand various provider performances associated with particular illnesses and procedures.  In addition to providing access to all of the now hundreds of thousands of individual claim codes, we provide two tools:

4,000 plus pre-built and validated code groups. The Agile Provider Profiling Platform™ comes equipped with pre-built “clinical groupers” make it easier to analyze patterns of diagnoses and procedures in order to understand the various provider Experiences, Outcomes, Appropriateness and Costs associated with particular illnesses and procedures. Pre-built code groups include:

  • All 48 Bundled Payments for Care Improvement (BPCI) Clinical Groupers / Code Groups
  • All 467 Diagnostic Related Group (DRGs)
  • All 290 AHRQ Clinical Classifications (CCS) single-level Clinical Groupers / Code Groups for diagnoses
  • All 729 AHRQ Clinical Classifications (CCS) multi-level Clinical Groupers / Code Groups for diagnoses
  • All 231 AHRQ CCS code groups for CCS) single-level Clinical Groupers / Code Groups for procedures
  • All 405 AHRQ CCS code groups for CCS) multi-level Clinical Groupers / Code Groups for procedures
  • All 79 CMS Hierarchical Condition Categories (HCC)
  • All 63 CMS Prescription Drug Hierarchical Condition Categories (RxHCC)
  • All 27 NHSN Principle Operative Procedure Categories

Plus an unlimited number of custom code groups. Users can build a code group that ideally suits their specific needs by copying a code group that is close and editing by adding and or deleting codes from an all-inclusive list.

Our custom code grouper builder tool: Built into the Agile Provider Profiling Platform™ comes is a custom code group builder tool. You can start de novo and build a custom code group from scratch. Or, you can take one of the 4,000 plus pre-built code groups or another custom code group you previously built and copy it for further editing where you can easily add or delete codes from a library of “all codes”. This tool gives you the ability to customize a “clinical grouper” or “code group” to match your business question in minutes. When you have built your custom code group, you can keep it private for your use only or share and publish using criteria you control.

Mix and Match: any pre-built standardized measures of outcomes to any of the pre-built groups of conditions or procedures and run a peer-to-peer comparison of HCPs, HCP Groups and HCO Facilities nationally.

Drill down to see results of your provider customers as well as their competitors.  Use these customized comparisons for analyzing whether their operations are in line with where they need to be for value-based reimbursement programs like the forced bundling that is coming.  Simply put, if your experience (volumes of patients and cases), outcomes and costs are not in line with where they need to be, you need to know.

 

Benefits: value-based reimbursement ultimately shifts risk from the payer to the provider. Providers with: (i) below average performance (measured by objective analyses of Experience and Outcomes) and (ii) above average Costs, either have to get better at performing that condition or procedure or exit that line of business.  We believe that as risk shifts, patient flows will shift as well.  Are you ready?  We can show you if you are.

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