Episode of Care

What is an episode of care?

An episode of care includes all the services provided to a patient to treat a clinical condition or procedure. The services included in an episode of care occur within a specific period of time and from a range of organizations that make up an integrated system.

An episode of care plays a key role in episode-based payment or bundled payment programs as the healthcare industry shifts towards value-based care reimbursement models.

An episode of care is typically initiated with a referral or admission and ends with a discharge.

Why are episodes of care important in healthcare?

Episodes of care bundle all services provided within a specific time frame for a single health condition or medical event instead of using a fee-for-service model. By bundling all these services, care becomes more comprehensive and there is also a cost reduction.

These two primary benefits of episodes of care programs, quality of care and cost reduction, are interrelated. This is because financial incentives offered for episodes of care are based on improved patient outcomes. This means that better patient care lowers costs while also making the entire healthcare process more efficient.

Additionally, by having a single price for all phases of care for a patient, all clinicians working together can better focus their efforts on the long-term outcome, not just completing a single aspect of the care.