The data elements in Pathfinder's data marts are grouped by Episode Treatment Groups™ (ETGs) and Episode Risk Groups™ (ERGs), along with Integrail proprietary business rules. For clients that prefer working with Adjusted Clinical Groups™ (ACGs), Pathfinder can be licensed with ACGs rather than ERGs¹.

For more information, contact us to request an electronic copy of 'Understanding the Episode Building Methodology in Integrail Solutions'.

Episode Treatment Groups

Episode Risk Groups

Adjusted Clinical Groups

Episode Treatment Groups

ETGs, developed by Integrail partner Symmetry Health Data Systems, are illness-based classifications that identify episodes of care. An episode is a series of care services for a given patient for a given condition. For example, a person being treated for a broken leg and for hypertension would be classified into two distinct ETGs and receive a number of care services within each, such as referrals, procedures and medications.

In Pathfinder, over 600 ETGs and Sub ETGs are aggregated into 22 major practice categories, allowing both high-level and drill-down analysis. ETGs let you track care over time and identify successful or less successful treatment patterns.

Examples: Uses of ETGs in Pathfinder Analysis

• Provider Comparison - Compare treatments of specific episode types among providers within a specialty or across specialties.
• Quality and Efficiency of Care - Examine how physician referral patterns for specific ETGs affect overall efficiency and quality of care.
• Impact of Medicines - Discover how prescriptions and other medicines impact quality and cost of care across ETGs.

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Episode Risk Groups

ERGs, also developed by Integrail partner Symmetry Health Data Systems, use ETGs as building blocks and measure illness burden. ERGs serve as the basis for Pathfinder's Risk Profiling component. ERGs provide an array of tools for evaluating certain central facts. First, that illness burden varies across patient populations. And second, that even when such uneven distributions are factored into an analysis (i.e., patient populations are risk adjusted), the health care choices made by providers can vary widely.

Illness Burden is a measure of the relative resources expected to be required for an individual's medical care. Illness Burden can vary for many reasons, including an individual's current health, genetic make-up, socio-economic status, and environment. Disease is not distributed randomly in a population; therefore utilization of healthcare resources varies greatly from person to person.

Examples: Uses of ERGs in Pathfinder Analysis

• Identify At-Risk Members for Proactive Intervention
• Analyze Illness Burden and Cost Trends
• Determine High Risk Conditions for Future Disease Management
• Evaluate Effectiveness of Providers
  

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Adjusted Clinical Groups

ACGs, developed by Integrail partner Johns Hopkins University, are the nation's most widely used groupings for identifying the risk – or illness burden – associated with patient groups. Patients are assigned to an ACG using a combination of diagnosis codes, age and gender. A given patient belongs to only one ACG. ACGs help identify a provider's case mix.

Examples: Uses of ACGs in Pathfinder Analysis

• Provider Profiling – Compare a provider's pattern of practice to that of other providers, while accounting for case mix.
• Capitation – More equitably distribute dollars based on patients' clinical characteristics as defined by their ACG.
• Cost Prediction – Generate more accurate predictions of cost and need for health care resources based on ACG case mix and severity of illness.

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¹If Pathfinder is licensed with ACGs, prospective risk prediction is not available within the product.

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