EAPG users: Get a little help from your friends

April 26, 2021 / By Gregg Perfetto

As the song goes, sometimes we need “a little help from our friends.” As many organizations are learning from the COVID-19 pandemic, needs often exceed resources, so it makes sense to consider and benefit from the experience of peer organizations when and where we can.

Addressing the growing ambulatory care space is just one of those areas where more attention is needed to better understand costs and the quality of the care being provided. There are numerous ways to do this and one is Enhanced Ambulatory Patient Groupings (EAPGs). Designed to manage non-Medicare outpatient populations, the EAPG classification methodology can help analyze cost and quality in the ambulatory environment, especially when combined with performance measures such as 3M’s outpatient potentially preventable visits (PPVs) methodology. 

What can EAPG users offer in terms of lessons learned?

Flexibility: First is the ability to customize EAPGs when setting up an outpatient payment system. Tailoring the grouping and claims payment options to specific requirements can help your organization achieve its goals. Additionally, the ongoing support of EAPG analysts helps you periodically make changes and updates to your use of the EAPG methodology to meet future needs and to help you effectively manage your outpatient population for many years to come.

User experience: There isn’t one single method of managing outpatient claims payment.  Each payer that uses EAPGs does so in different ways. How can you benefit from the experience of others? First, join the EAPG quarterly conference calls hosted by 3M Clinical and Economic Research, the team that developed the EAPG methodology. Not only are they the experts in everything outpatient, they offer resources for learning about new or optional ways to utilize EAPGs. Participation in EAPG quarterly conference calls will keep you informed about changes or updates to EAPG logic or functions, some of which occur as a result of user input, and also from open discussion during the call. Attendees not only have the opportunity to ask questions of the 3M Clinical and Economic Research team, but also can participate in discussions with other attendees, learning how others are using EAPGs and gain insights from their experiences managing outpatient populations. What do they see down the road impacting their overall management of outpatient care and what steps can they take now to meet new challenges head on?

The EAPG quarterly meeting is one of several ways to benefit from the experience of others. 3M offers multiple levels of interaction with EAPG users. Already mentioned are the 3M Requirements Analysts who capture and maintain complete sets of specifications of EAPG implementation for each individual payer. Of equal, or possibly even greater value is the ability of analysts to pass on a user’s non-proprietary setup to other users. This information is invaluable for ensuring that organizations are realizing the most benefit from EAPGs. Finally, 3M Health Information Systems consultants, experts in ambulatory patient and payment management, can bring their knowledge and experience working with payers and providers to help your organization manage your outpatient population.

Don’t feel you are in an EAPG bubble! Learning from the experience and insights of others to boost the benefits you gain from EAPGs. And, keep in mind, you can provide valuable input to others too. So, I encourage you to participate in the EAPG quarterly meetings and consider reaching out to others using EAPGs. Managing outpatient populations can be a daunting task, so take advantage of the ideas you and other users can share about effective use of EAPGs.

Gregg Perfetto is a Payer Account Manager for the Regulatory and Government Affairs team at 3M Health Information Systems.