There's a Story in Your Claims Data. Episode Grouping Helps You Tell It.

When someone on your health plan is diagnosed with diabetes, what does that actually cost your organization? Not just the office visit—but the lab work, the specialist referral, the prescriptions, the follow-up care over months or years?

It's a relatively simple question at face value, but the answer is much more complex, especially when it’s lost in a messy claims feed and relies on accurate accounting over long periods of time. Fortunately, there is a framework in healthcare analytics for organizing that mess, and that framework is called episode grouping.

What episode grouping does

Claims data on its own is a collection of individual transactions. An office visit here, a lab test there, a prescription filled somewhere else. Without a way to connect those dots, there's no way to know whether a pain medication claim belongs to Leo's appendectomy or Carol's hip replacement, let alone what either episode actually cost.

Episode grouping connects those dots, linking related medical and pharmacy claims across providers and settings into a single, coherent picture of a patient's treatment for a given condition. Think of it as the difference between reading a list of receipts and reading a story. Episode grouping tells you what happened, not just what was billed.

That view unlocks a lot: the true total cost of treating conditions across your population, how efficiently different providers manage the same diagnoses, and where care management programs might make the most difference.

Today, we're thrilled to share that Artemis has upgraded the episode grouping methodology powering episode-of-care analytics across our platform.

Why we upgraded

Our commitment at Artemis is to give you the most accurate, actionable view of your population's health, and that means continuously evaluating the methodology behind our analytics. A few things we're particularly excited about:

Chronic conditions tracked continuously. Rather than resetting at the end of every calendar year, the updated episode grouper tracks chronic conditions on a rolling 12-month basis—following conditions like diabetes or heart disease the way care actually unfolds over time.

Higher claims capture. Approximately 90% of claims now get grouped to an episode, up from around 80% previously. More grouped claims means a more complete and reliable picture of your population's healthcare experience.

Benchmarking capabilities. The new episode grouper allows us to provide benchmark comparisons, giving you meaningful external context alongside your own data trends.

The upgrade is live in the platform for Artemis clients, and we're excited to help our customers make the most of what's new.

Have questions? Reach out to artemis@nomihealth.com