DiseaseBenchmarks

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Healthcare organizations can now reliably compare and evaluate cost and resource data.

Disease Benchmarks™ Program Overview

The Disease Benchmarks® Program, including this Disease Benchmarks® website, offers a new generation of resources that will help fill the recognized industry need for independently-generated, patient-centric, disease focused, real-world, evidence based information. At the nucleus of these resources: Disease Benchmarks®—a qualitatively new class of healthcare data.

Disease Benchmarks® originated in 1998 with the help of a distinguished advisory group of Medical and Pharmacy Directors who were all looking for an independently generated, credible set of disease-specific economic norms that would enable them to compare their own health plans’ data to a national standard. It took numerous meetings and two years to develop the Disease Benchmarks® Program and its resources but the effort was worth it as it quickly became an industry standard and help meet the evidence based medicine needs of key decision makers in the industry. EBM relies on objective, comparative norms and benchmarks. Comparative norms and benchmarks require comprehensive and representative databases. Those elements are at the core of the Disease Benchmarks® Program.

Disease Benchmarks® are built through a proprietary process that utilizes proprietary data models (Disease Models™ (Patent Pending)) to organize and stratify episode-based claims data, derived from an independent third party data database, into easily digestible, and easily accessible, benchmarks. These benchmarks report, for example:

Detailed patient demographics (e.g., geographic region, age, gender).
Markers of disease severity, including complications and comorbidities.
Utilization of ancillary services (e.g., diagnostic and laboratory services, surgical procedures).
Patterns of pharmacotherapy (e.g., the brands or classes of prescription drugs used).
Facility utilization (e.g., inpatient admissions, LOS, ER utilization).
Payers including Commercial, Self-insured Employers, Managed Medicaid and Medicare Advantage.
Practice patterns of the physician specialties that actually treat the specific disease being analyzed.
Episode costs and resource utilization across the continuum of patient care services (inpatient, outpatient, emergency room/urgent care, pharmacy).

Disease Benchmarks ® represent a marked improvement over prior generations of benchmark data, because they holistically reflect, across the healthcare continuum, and for completed patient episodes, (a) how clinicians—in a "real world", managed care environment—actually treat a disease based on patient evaluation (age, severity, complications, and comorbidities) and currently available treatment options, (b) the treatments actually given for that disease and by whom they are given, and (c) how much it costs, and how many resources are deployed, to treat that disease.

Moreover, Disease Benchmarks ® align naturally with the data-driven goals of EBM to answer the current business imperatives to improve overall quality, and contain costs, because:

Disease Benchmarks® consist of objective, comparative national and regional benchmarks—derived from independent, representative, competitive position-neutral databases.
In harmony with the stated goals of “true benchmarking,” Disease Benchmarks® better enables healthcare professionals to:

- Identify best performance: compare performance among healthcare organizations and providers, and gauge their own organization's performance, by comparing internal cost and resource utilization data for a specific disease against independently developed national and regional benchmarks.

- Determine how that performance is achieved: understand the total costs of care for a disease, and how factors such as patient demography, severity, complications, comorbidities, and mode of treatment impact resource utilization and costs.

- Apply the lessons learned: identify areas needing improvement, adjust disease treatment and disease management strategies for better results, and check whether performance is improved after actions taken to improve care are implemented.

Disease Benchmarks® also align with HIPAA: they are generated using the same ICD-9, CPT and NDC code sets that are mandated by HIPAA, and consist of aggregated, de-identified data that is consistent with HIPAA's privacy mandate.

In sum, Disease Benchmarks®, by definition and design, “give full expression to the reality of medical care,” and can be used to help “evaluate the relation of healthcare inputs to healthcare outputs.” Disease Benchmarks®—and the other tools and resources that are available only through the Disease Benchmarks® series—delivers to the healthcare professional the improved capability to understand resource utilization, and to make better-informed disease treatment and management decisions. This improved capability is essential for providing better patient care and thriving financially in the current marketplace.

Disease Benchmarks™ Program Overview

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