Looking at military health system surgical procedures through the lens of an episode grouper

Background

With mounting accountability pressure on their publicly funded health system and the demand for a medically ready military force, the military health system (MHS) employs a strategy to optimize care delivery. Research suggests that analysis of episodes of care is a valuable tool for identifying the relative resource use for a given procedure and can direct enhancements in care delivery.

Methods

This proof-of-concept study investigates the feasibility of grouping services for surgical patients into episodes of care. These episodes of care served as a unit of analysis for evaluating resource use within a public healthcare system. Borrowing from a grouping tool developed for the Centers for Medicare and Medicaid Services by Brandeis University, we developed methods to employ it with MHS clinical encounter and claims data. Data included all care paid for by the MHS from FY2009-2015, including care delivered inside and outside of their facilities.

Results

Using this analytic grouping tool, we grouped 49 percent of our administrative data into episodes of care. In these episodes, we see variation in both the care provided directly by the MHS and care provided by the network of private sector providers in rates of sequelae based on the service area for specific surgical procedures.

Conclusions

We offer a novel tool for health systems to evaluate their practice patterns, which can generate valuable strategies for efficiency gains and slowing spending.

Implications

Outside of the traditional population-based metrics to evaluate efficiency, episodes of care are a valuable tool for identifying the mix of services used to produce a given surgical outcome.