Claims Date V's Cost Effective Analysis

Now that both Medicare and many private insurers are becoming even more cost conscious as to how they reimburse medical providers and institutions for care administered to patients, it is important to analyze both how care has been administered, and how it can be modified in the future to maintain good quality of care, but rein in costs.

Historically, claims data has often been used in the analysis of costs. This seemed reasonable as claims data describes how services are historically reimbursed. However, it cannot compare one method of care vs another, nor if what was actually paid is either cost effective or even necessary. At the detail level necessary to make critical care delivery decisions, claims data represents the proverbial 30,000-foot level, not the, on the ground, level necessary for careful care planning necessarily predicated on both cost and quality.

Cost effectiveness analysis provides a much better framework for comparing different therapies, multiple approaches to therapies, outcomes tracking and a nearly infinite number of variable effecting both care quality and care costs.  Cost Effectiveness Analysis works because it values and tracks both cost containment and its medical effectiveness. It does not rely on history, but upon probabilities of outcomes for actually therapeutic regimens. This will not only provide a framework for comparison, but will lead to development of benchmarks for comparing different types of therapies or therapeutic approaches to a particular medical problem.

Claims data can still be useful, but will provide an added benefit when used in conjunction with cost effectiveness analysis.  In this scenario, cost effectiveness analysis can be used first to realistically model the outcome of a particular treatment and provide a benchmark.  Then one can use the line items of the claims data to see where one could cut costs while maintaining quality of care. This way utilizes both types of analysis to give a complete financial picture of clinical treatments, including probabilities of outcome.  

In conclusion, cost effectiveness analysis can provide realistic assessment of a clinical situation and provide a financial benchmark that claims data just cannot do.