Clinically Credible Episode Grouping

ArborMetrix defines clinical procedures and conditions based on specific CPT, ICD-9, and ICD-10 codes, not just financial DRGs. Clinical logic excludes unusual patients that can invalidate comparisons and undermine credibility with physicians.


With Price Standardization

Standardized prices for all services are calculated using reference fee schedules. This allows for accurate comparison of utilization patterns across providers by eliminating cost variation due solely to contractual payment rates or CMS adjustments.  Standard pricing also facilitates analysis of utilization trends across years by factoring out annual price changes.

For Success With At-Risk Contracts

All claims associated with a patient’s condition or procedure are linked, including professional fees, readmissions, and post-acute care such as home health, rehab, and SNF. Episodes encompass any related services in the relevant 30- or 90-day window, aligning costs with bundled payments.

Flying Blind into an At-Risk Future?

In the rapidly shifting sands of the Affordable Care Act and evolving reimbursement, insurers, health plans, and Accountable Care Organizations need actionable intelligence to guide their decision making. Unfortunately, they often operate largely in the dark. Without rich clinical information it’s impossible to determine the appropriate risk-sharing model.
How typical Business Intelligence solutions fall short:
  • They provide an incomplete picture when tracking a patient’s course of care for a single procedure or condition. They base their analysis on inpatient claims only, ignoring data from pre-admission and post-discharge.

  • They fail to gain credibility with physicians due to lack of clinical granularity. Clinical depth is often limited to the discharge DRG.

  • They unfairly assess and compare hospital and physician performance with inadequate risk adjustment, or no risk-adjustment at all.

“Seek out innovation. Accountable care is coming fast, and risk-based contracting is increasingly prevalent.  As providers seek to best manage operations, processes, and costs to deal with these business challenges, analytics are a core capability.”

- 2015 IDC Health Insights

ArborMetrix Shines Light on Risky Variation

Informing Cost-effective Value-based Purchasing Strategies and Episodic Bundling

Break through the data clutter and obtain clinically relevant, scientifically robust performance information with:

  • A complete picture of each patient’s course of care for their acute care procedure or condition. Facility and professional claims are intelligently grouped within 90 days of the index admission including pre-admission, inpatient, and post-discharge.
  • Deep clinical granularity that is highly accurate and actionable to drive physician adoption. Going beyond hospital DRGs, ArborMetrix evaluates all diagnosis and procedure codes included in each professional and facility claim.
  • A fair assessment and comparison of performance to ensure credibility with physicians. The ArborMetrix platform fully risk- and price-adjusts to ensure “apples-to-apples” comparisons.
Learn More about this Solution

What Our Customers Are Saying

Atrius Health, a Pioneer Accoutable Care Organization (ACO), is Powered by ArborMetrix


"As a Medicare pioneer ACO, it is tremendously challenging and time-consuming to identify and cost each of the components of an episode of care. ...After evaluating several episode grouper products, we were most encouraged with the technical and analytic capabilities within the ArborMetrix solution."

Joe Kimura, MD, MPH
Chief Medical Officer, Atrius Health

Watch the On-Demand Webinar

Using Clinical Intelligence to Manage an ACO’s Specialty Care Network

This live webinar was held in partnership with the HIMSS Clinical and Business Intelligence Community. Led by Paul Henchey, M.S., and featuring guest speaker, Joe Kimura, M.D., M.P.H., Deputy Chief Medical Officer, Atrius Health.

Watch the Webinar Now