title: Episode of care analysis reveals sources of variations in costs.
abstract: OBJECTIVE
  To understand and reveal the underlying sources of inter- and intraplan variation in a selected number of chronic and procedural episodes.
  
  
  METHODS
  Analysis of allowed claims from 9 regional health plans covering commercially insured populations in different areas of the United States.
  
  
  METHODS
  Use of the PROMETHEUS Evidence-Informed Case Rates analytics to 1) calculate total plan costs and cost of specific episodes, 2) create price and severity adjustments, and 3) determine coefficients of variation.
  
  
  RESULTS
  The interplan coefficients of variation for total per member per year costs and per episode costs vary from 0.1 to 0.55, while the intraplan coefficients of variation vary from 0.4 to 5.5. In both analyses, the coefficients of variation for potentially avoidable complications (PACs) were higher than the coefficients of variation for typical costs.
  
  
  CONCLUSIONS
  There is significant variation in episode costs within a plan, and PACs have significantly more variation than typical costs. Plans and accountable care organizations would benefit from understanding the source of variation of their episode costs in order to improve overall cost of care.
authors: Health Care Incentives Improvement Institute, Inc, 13 Sugar St, Newton, CT 06470, USA. francois.debrantes@hci3.org
authors: Francois
authors: F
authors: de Brantes
authors: Amita
authors: A
authors: Rastogi
authors: Christina M
authors: CM
authors: Soerensen
mesh_terms: D017050:Episode of Care; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D014481:United States