Episode treatment groups: an illness classification and episode building system--Part II.

The episode treatment group (ETG) methodology is a case-mix adjustment and episode-building system that uses routinely collected claims data. The resulting 558 clinically homogeneous groups adjust for severity by the presence of complicating conditions, comorbidities, and other characteristics of a patient's condition that affect resource utilization. The groups identify both complete and incomplete episodes in addition to those episodes which, from a cost perspective, are either low or high outliers. As a grouping ¿engine,¿ the user controls the amount and format of the claims data as input, providing essentially unlimited provider profiling, demand analysis, disease management, and capitation and predictive modeling possibilities.