2022 Validation Report
Review for: Edison Healthcare
Validation Achieved: Savings
Savings Valid Through: September 2022
Company Profile
Category:
Special Travel Network
Website:
Public or Private:
Private
Year Established:
2013
President:
Tom Emerick
Company Contact:
Description:
Edison Healthcare believes that distance and cost should never get in the way of receiving the best possible medical care. Edison client’s and their employees have access to Edison’s Smart Care Network, a handpicked network of America’s best medical centers. Edison believes the best healthcare outcomes for the most complex and costly diagnoses will come at the hands of the best surgeons, physicians and medical teams who work for the best medical centers in America. That is what Edison Healthcare does, it delivers extraordinary outcomes from phenomenal medical centers.
Claim Assertion
Edison’s program send patients to high-quality providers, with the goal of correct diagnosis and efficient treatment. Travel costs and arrangements to see the designated providers are handled by the program so that employees do not have barriers to care.
Intervention link to outcome
- Summary of intervention
- Edison provides a medical travel program that sends patients to high-quality providers. The goal is to ensure correct diagnosis and efficient treatment.
- Describe the outcome being measured
- The employer’s Return on Investment (ROI) from adopting the Edison program.
- Has the applicant shown with published literature or other credible sources that the outcome being measured is correlated with the intervention being described?
- No, though there is literature available supporting this model’s impact on costs. See Health Affairs 2017 Dec;36(12):2094-2101, Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design. (https://www.ncbi.nlm.nih.gov/pubmed/29200355) A brief search did not uncover published literature on centers for excellence having superior performance on diagnosis accuracy.
Method/Calculation/Examples
Edison provides an online calculator that estimates, based upon an employer’s number of lives, the frequency of certain conditions and the use of the travel program. Costs for the travel program and the care delivered by the designated providers is compared to costs for the same services from other providers. Credible sources were used for the non-program providers; in addition, the user can supply his/her own plan’s data in the calculator.
Savings are stated net of the program fees, except for the initial set-up charges.
Data Source
- Describe the data source
- The data source for the ROI estimates is not specified. We assume it is based upon the validated calculator, which is available at https://edisonhealthcare.com/roi-calculator . Users need a password to enter the calculator: ehroi.
- Did the applicant have adequate data from a credible, reliable source?
- The calculator cites credible sources for each component of its calculator.
- Is the data source appropriate for the outcome being measured?
- Yes.
- Comment on the overall quality of data source.
- Edison used several different sources, all of which are credible and used correctly in the calculator.
Findings & Validation
Using credible estimates, the costs for the program’s designated providers are lower than comparable providers. Since the fees are triggered by a member’s using the program, the employer’s risk of having higher costs is minimized.
Outcome Measure
- Describe the outcome measure
- Savings from using the travel medical program compared to local providers; number of patients likely to use the Edison Program. Savings are stated net of Edison’s program fees.
- Is the outcome measure reflecting something important to health improvement, quality of care, and/or value/ financial savings?
- Getting care from efficient, high quality providers is an important goal.
- Describe the overall approach – a trend from pre- to post-, comparing similar groups, etc.
- The calculator estimates how many procedures an employer group is likely to have in a particular year, and what percentage of those could be referred to the travel program. The savings is based upon the travel program’s average cost for those procedures compared to the costs at non-COE providers.
- Did the applicant use the data source correctly to compose the measure?
- Yes.
- Comment on any issues with compiling the measure, such as missing or incomplete data or lack of data on non-participants.
- The calculator was validated by the Institute, so has already met standards for credibility and reliability of data sources, as well as reasonableness of assumptions.
Bottom Line
- Did the applicant clearly trace a correlation between the intervention, the outcome, and the measure?
- Yes, the comparison of Centers for Excellence care to non-COE providers is clear. By directing patients to COEs, costs are reduced in two ways: patients who do not need care are referred to alternatives; and patients who need care get it from lower-cost providers.
- Were there significant flaws in the data source, measure approach, or other aspects of the application?
- No.
- Highlights of analysis
-
- The high number of lives offered the program.
- The program design, which allows patients to easily use the high quality, lower cost providers.
- The use of a validated calculator with reasonable assumptions and credible data sources for parameters.
Limitations
Participation in the program may lead to a member’s diagnosis getting changed, and therefore the care plan. This could lead to additional savings or additional costs. This is not addressed in the savings estimates.
- Areas of Opportunities
- The lack of a case study of an employer’s actual savings.
- The lack of explanation about the ROI estimates in the application. (ROI estimates from the actual calculator are quite clear, however.)
Validation and Credibility Guarantee
Edison Healthcare’s Edison Travel Program achieved validation for Savings. Validation Institute is willing to provide up to a $25,000 guarantee as part of their Credibility Guarantee Program. To learn more, visit https://validationinstitute.com/credibility-guarantee/.
Program Validation
Program has strong evidence of significant impact on both patient outcomes and on medical costs. Evidence is assessed based upon the certainty it provides that the result is due to the program and not to other factors, such as recruiting people to participate in the program who are most likely to succeed.
Savings
Can reduce health care spending per case/participant or for the plan/purchaser overall.
Outcomes
Product/solution has measurably improved an outcome (risk, hba1c, events, employee retention, etc.) of importance.
Metrics
Credible sources and valid assumptions create a reasonable estimate of a program’s impact.
Contractual Integrity
Vendor is willing to put a part of their fees "at risk" as a guarantee.
About Validation Institute
Validation Institute is a professional community that advocates for organizations and approaches that deliver better health value - stronger health outcomes at lower cost. We connect, train, and certify health care purchasers, and we validate and connect providers delivering superior results. Founded in 2014, the mission of the organization has consistently been to help provide transparency to buyers of health care.
Validation Review ProcessValidation Institute has a team of epidemiologists and statisticians who review each program. The team focuses on three components:
- Evidence from published literature that a similar intervention had similar results.
- The reliability and credibility of the data sources.
- The rigor of the approach to calculating results
To achieve validation, the program has to satisfy each of these components. VI’s team then summarizes the review into a report which is publicly available. Details of VI’s review are available with the program’s permission.
