HCI3’s Episode of Care definitions are procedure and diagnosis codes grouped together to outline the entire range of treatment for more than 90 conditions. These include all covered services across all providers that would typically treat a patient for a single illness or condition (hospital, physicians, laboratory, pharmacy, rehabilitation facility, etc.) HCI3’s definitions are the only open source episode definitions that can be used for multiple purposes, including bundled payment and ACO payment programs, reference-pricing initiatives, and for cost and quality analysis of providers.
All these definitions are available for public use as part of the overall HCI3 mission to improve the quality and affordability of care. There is a need for scientifically designed and validated episode of care definitions that have a multi-purpose use. Because the definitions are available, implementations of payment reform programs and cost and quality analysis initiatives have a comprehensive starting point from which to build.
These definitions also are used in HCI3‘s PROMETHEUS Analytics program to formulate episode budgets, or Evidence-informed Case Rates (ECRs).
Some documents may refer to the Episode of Care definitions by their previous name, Evidence-informed Case Rates (or ECRs). Those titles soon will be updated, but the related content remains valid.