Procedure Episode Groups

In the interest of advancing the national conversation on performance measurement, OptumInsight is providing stakeholders the ability to access, understand, and potentially improve our methodology for grouping surgical episodes.

Identifying procedure episodes and the services involved in their management has become a key business need of any health care organization. Procedure episodes provide a valuable unit of analysis to measure health care and provide incentives for high performers. We seek to improve the understanding, utility, and quality of Procedure Episode Groups (PEG®) with an eye toward better and more consistent calculations of key surgical quality and cost metrics.

While PEGs provide a way to understand and compare surgical episodes across patients, providers, and populations, they also need to evolve to reflect the increasingly complex nature of care. Public review of the methodology marks an ambitious advance in that evolution. We invite you to be a part of this dialogue and contribute to the performance measurement discussion.

About PEGs
PEGs provide health care organizations with an enhanced approach to measuring the performance of surgical providers. PEG methodology uses carefully designed algorithms, based on clinical guidelines and a complete understanding of the complexity of medical claims data, to facilitate accurate identification and thorough development of complete procedure episodes.