CHI Health Cost Report
The Average Spend Per Episode of Disease
If you or someone you care for has ever been hospitalized, you know that how much you pay is not determined by the hospital bill alone. Most people end up with a stack of bills from the hospital - anesthesia, imaging, a doctor and maybe the surgeon, pharmacy, and rehab - that are incurred across an episode of disease. To control health care costs it is imperative that providers and health plans work together to manage these total costs across episodes of disease.
CHI Health is committed to helping manage the total cost of care with our regional clinically integrated network, UniNet. We pledge to be transparent in publishing our costs on the most common episodes of disease that largely drive health insurance premiums, and accountable for reporting back to the public on progress we are making to reduce our costs to below the regional average.
As a starting point, CHI Health is at or below the regional average for 8 of the top 10 most common episodes of disease that bring a Medicare patient to the hospital (See Table below). Keep in mind that the average spend for an episode of disease includes all costs incurred by the insurer, in this case Medicare.
CHI Health at or Below Regional Average Payment for 8 of the Top 10 Episodes (Based on Volume)
Source: CMS Standard Analytical File CY 2013. Note: 2014 data will not be available until November 2015
The data set used to generate the analysis in this document is sourced from a Standard Analytical File (SAF) provided by the Centers for Medicare and Medicaid Services (CMS). The SAF include all Medicare claims for non-Critical Access Hospitals for any beneficiary enrolled in a Medicare HMO for at least part of the year (and not in Part A or Part B) with an “anchor admission” at a CHI Health hospital in Calendar Year 2013.
The geographic region for purposes of comparison is defined by CMS as the Omaha – Topeka, KS geographic region. The CMS Episode of Care SAF specifically excludes:
- Any End Stage Renal Disease (ESRD) episodes
- Any episode with an anchor admission at a different hospital
- Any claim for a DRG not part of BPCI
- Any episode where the patient died during the anchor admission.