Measuring and improving the quality and efficiency of health care.
Performance measurement is critical to achieving durable health care reform that truly improves cost and quality of care by enabling value-based purchasing and performance-based incentives. Yet performance measurement poses one of the biggest challenges in the U.S. health care industry: What elements make up a fair, accepted system for assessing the quality and efficiency of care provided to patients?
To that end, Optum offers an online code mapping database, providing transparency into the methodology behind our patented Episode Treatment Groups (ETG) software. We believe this is an important contribution to advancing the national performance measurement conversation. Any interested stakeholder can access and understand our leading methodologies for grouping episodes of care.
It's a critical step. Care purchasers, government entities, health plans and patients demand increased transparency into the cost, quality, and service delivered by physicians and hospitals. At the same time, physicians and hospitals need insight into how they are measured.
We believe that meaningful engagement from multiple constituents is essential to the development of an industry-wide measurement system that is standard and trusted.
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Optum has made an important contribution to advancing the national performance measurement conversation, as any interested stakeholder can now access and understand our leading methodology for grouping episodes of care.
Identifying clinical episodes of illness and the services involved in their diagnosis, management and treatment has become a key business need of any health care organization. Episodes of care provide a valuable unit of analysis to measure health care and provide incentives for high performance. We seek to improve the understanding, utility and quality of Episode Treatment Groups which will lead to better and more consistent calculations of key health care quality and cost metrics. While ETGs have been widely used to understand and compare episodes of care across patients, providers, and populations; they are also constantly evolving to reflect the increasingly complex nature of care.
Since ETGs were introduced in the mid-1990s, the clinical richness of episodes of care and their reliance on information readily available from medical and pharmaceutical insurance claims make them a sound unit of analysis to support transparency, measure health care quality and cost, and provide incentives for higher quality care. Today, ETG-based products are licensed by more than 300 U.S. health care organizations, serving more than 75 percent of the insured population.
To learn more about ETG, click here and download the whitepaper.
Procedure Episode Groups (PEGs) provide health care organizations with an enhanced approach to measuring the performance of surgical providers. PEG methodology uses carefully designed algorithms, based on clinical guidelines and a complete understanding of the complexity of medical and pharmacy claims data to facilitate accurate identification and thorough development of complete procedure episodes. Identifying procedure episodes and the services involved in their management has become a key business need of any health care organization.
PEG identifies a unique procedure event as well as the related services performed before and after that procedure, creating a procedure episode. Procedure episodes describe not only the surgery itself, but the entire sequence of care, including workup and therapies prior to the procedure and post-operative activities such as repeat surgeries and patient follow-up. Within the ETG Transparency site, a full list of PEG Anchor Categories is available.
To learn more about PEG, click here and download the whitepaper.
ETG Clinical Knowledge Database - Optum Clients Only
Access to this content is limited to clients with active licenses for Symmetry or Impact Products. If you already have a login for this site, you can login through this link. If you do not have a login, you must contact your client manager for approval and to obtain credentials.
ETG Transparency Site - Open to Public
This site contains public information on Episode Treatment Groups® (ETG®). If you already have a login for this site, you can login through this link. If you do not have a login, follow the self-registration prompts to get access.
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