⚡ New: Value-Based Care Infrastructure

The only surgical platform with
90-day episode tracking built in

CJR is mandatory in 188 MSAs. BPCI-A is live across thousands of practices. Your competitors use spreadsheets. CaseFlow ships the VBC operating system.

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188
MSAs with mandatory CJR
$1,800
Avg margin per CJR LEJR episode
when SNF leakage is controlled
90
Days of post-acute cost exposure
per episode
0
Competitors with native
episode tracking
ROI Math

What better episode management is worth

A 100-episode CJR portfolio. Average target price: $24,500. 15% of episodes have SNF leakage averaging $4,200 each.

15 leakage episodes × $4,200 avg leakage cost → $63,000/yr in recoverable margin
$63,000
Annual margin saved per 100 CJR episodes
At 500 episodes (mid-size PE platform): ~$315,000/yr. This is before readmission prevention and SNF network steering.
What's Included

Every layer of episode management, shipped

📋
Episode Registry
CJR LEJR, CJR Hip Fx, BPCI-A Spine, BPCI-A Bariatric, BPCI-A MJRLE, custom commercial bundles. Target price vs actual cost, margin auto-computed.
💰
Cost Capture
Line items by CMS bucket: anchor inpatient, SNF, home health, readmission, ED visits, outpatient PT, DME, Part B physician. Manual entry or CSV import from claims.
🔀
Leakage Detection
Auto-flags when patients report an out-of-network SNF or HHA via post-op check-in. Cross-referenced against your preferred PAC network list.
🚨
Readmission Risk
Day 1/3/7/14/30 check-ins already capture red flags. Fever, wound drainage, ED visit? Episode upgrades to high readmission risk and surfaces in surgeon dashboard.
👨‍⚕️
Surgeon Scorecard
Per-surgeon leaderboard: avg margin per episode, readmission rate, SNF avoidance rate. Top/bottom 5 with visual badges. Drives VBC bonus pool allocation.
🌐
Network Rollup
PE/MSO exec view: episode volume by practice, blended margin, leakage by location. Anonymized board-share via signed token — no login required for the CFO.
How It Works

From index hospitalization to reconciliation

1
Episode opens at anchor admission
A case in CaseFlow automatically maps to a CJR or BPCI-A episode type. Target price is set from your CMS reconciliation benchmark. Episode end = anchor date + 90 days.
2
Post-acute costs are captured as they occur
Staff logs SNF days, home health visits, PT sessions, and ED events. Claims feeds can also push line items automatically. Running total vs target updates in real time.
3
Patient check-ins trigger automatic leakage flags
When a patient's Day 7 check-in mentions a rehab facility, CaseFlow cross-checks against your PAC network list. Out-of-network = instant leakage alert to the care coordinator.
4
Red-flag replies escalate readmission risk
Fever, drainage, uncontrolled pain, or "I went to the ER" in a check-in reply upgrades the episode's readmission risk to HIGH and surfaces it at the top of the surgeon queue.
5
Episode closes and feeds the network rollup
At Day 90, close the episode and mark it reconciled. Surgeon scorecard and PE executive rollup update automatically. CFO gets a link — no login required.
Competitive Landscape

Why Phreesia, Relatient, and Solutionreach can't answer this

Capability CaseFlow Phreesia Relatient Solutionreach Health Gorilla
Pre-op / post-op SMS ✓ Partial ✓ ✓ —
CJR / BPCI-A episode registry ✓ — — — —
90-day cost capture by CMS bucket ✓ — — — —
PAC leakage detection ✓ — — — —
Per-surgeon VBC scorecard ✓ — — — —
PE/MSO network rollup (exec view) ✓ — — — —
AI readmission risk from check-in ✓ — — — —
Who This Is For

Built for VBC-mature surgical platforms

🏢
PE-backed ortho/spine platforms
HOPCo, OrthoAlliance, USOSM — managing CJR mandatory participation across 10–100+ locations. Board-level margin visibility is non-negotiable.
🏥
ASC management companies
SCA Health, USPI, Surgery Partners — voluntary BPCI-A participation requires episode infrastructure your EHR doesn't provide.
⚖️
Commercial bundle participants
Aetna, UnitedHealth, BCBS bundled payment pilots — same 90-day episode model, custom target prices. CaseFlow handles any episode type.

Stop managing your CJR episodes in Excel

Every week without episode tracking is margin leaking silently to out-of-network SNFs and undetected readmissions. We built the infrastructure. Book 20 minutes.

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