How Is An ECR® Created?

How Is An ECR® Created?

The original development and pilot-testing of ECRs were made possible due to the funding and support from charitable foundations including the Robert Wood Johnson Foundation, the Commonwealth Fund, the New York State Health Foundation, and the Colorado Health Foundation. These episodes were built by the PROMETHEUS Payment design team with the help of physicians who are experts in their respective fields, often members of their specialty societies, who volunteered their time and assembled in Clinical Working Groups.

These groups met to select a starter set of clinical conditions around which ECRs could be constructed. For each condition, the following needed to be determined:

  • Selecting clinical practice guidelines;
  • Analyzing the guidelines to determine the natural boundaries of the ECR;
  • Providing an estimate of the scope of services of the ECR, including the total units of service and the types of providers responsible for delivering those services as outlined in the guidelines;
  • Establishing a reasonable set of performance measures to be used to evaluate clinical performance of providers delivering services included in the ECR;
  • Identifying routine complications that are prevalent for patients who do not receive optimal care;
  • Participating in and supervising the data modeling of the ECR to determine the extent to which the results were valid

Today, the creation of ECR definitions are still through the collaboration of the HCI3 team and various Clinical Working Group Contributors who follow established principles and logic. Furthermore, after creating an episode, to ensure validity and reliability, the ECRs are run through different test databases and refined based on empirical data and feedback from the field.

Currently, over 80 definitions have been developed, and the ongoing organizational goal is to have developed enough ECRs to cover 80% of costs of care by 2015, all of which will be updated and made available for public use in the form of Summary Descriptions and machine-readable metadata files.

For more information on ECR definition development process, see the following papers and resources:

An Introduction to ECRs
What are Evidence-informed Case Rates (ECRs)? 
What is Prometheus Payment?
That Was Then, This Is Now
A New Payment Model for Quality: Why Care Now?
Evidence-Informed Case Rates: A New Health Care Payment Model
Making Prometheus Payment Rates Real
The Prometheus Payment Model