Studiomaca Episode Management

Studiomaca Episode Management, a highly configurable, rules-based solution for advanced reimbursement, combines clinical support and claims transaction functions to help support full-scale bundled payment programs, promote quality care, and reduce administrative and medical costs.

Helping Navigate the Complexities of Bundled Payments for Care Episodes

. But even though it’s a top method of value-based reimbursement (VBR) among health plans, it hasn’t seen widespread deployment. Why not? The labor intensity and high cost to scale a successful bundled payment program effectively will continue to hold health plans back from seeing the real financial potential of this model. Major challenges include:

  • Identifying and budgeting for target procedures
  • Defining an episode’s included and excluded components
  • Reimbursing all participating physicians fairly
  • Adjudicating and paying claims quickly and accurately in both retrospective and prospective models

Studiomaca Episode Management™ will help you develop and manage bundled payment programs that fit your plan’s specific needs – whether you are just starting to define your episodes, looking to make your retrospective approach more efficient, or ready to go full-scale with a prospective model. Our solution works within your current claim workflow to bring automation to both prospective and retrospective bundled payment programs using a rules-based approach. Take advantage of 22 standard episodes covering procedural, acute, chronic and other evidence-informed case rates, or tailor bundles to your specific program. Our solution gives you the flexibility to efficiently run a retrospective approach now and transition smoothly to a prospective approach when you are ready. Offerings include:

  • Retrospective bundled payment services — Let our Studiomaca analytics experts take on the administrative burden of helping you build your retrospective bundled payment program from scratch, or streamline an existing one.
  • Prospective bundled payment automation — Deploy the same rules and technical platform into your existing FFS workflow that we use in our retrospective service, allowing you to scale your programs by bundling claims real-time as they come in.
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