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The Prometheus Payment Program: A Legal Blueprint

Pay for performance (P4P) programs are sweeping the country in both public and private health insurance. Responding to the Institute of Medicine's call for new payment models to really advance quality, these initiatives are typically designed to motivate physicians to…

April 10, 2012

The PROMETHEUS Model: Bringing Healthcare into the Next Decade

From: Annals of Health Law Advance Directive p274-284

The United States’ current healthcare system has long been structured to emphasize the quantity of health care over the quality of health care. Such a focus of quantity is evident in the fee-for service structure, where providers are paid a specified…

April 10, 2012

Evaluating and Negotiating Emerging Payment Options

This “how-to” manual is intended to help physicians who are considering transitioning from fee-for-service payment to risk-based reimbursement. It covers the nuts and bolts of payment systems based on a physician’s ability to stay within a specified budget for health…

March 15, 2012

HCI3 Improving Incentives Issue Brief: Hospital Bed Supply and Hospitalizations

A Tale of Four Cities

Objective: To understand the relationship between the supply of hospital beds and the frequency of hospitalizations in four comparable U.S. cities. Methods: The Pittsburgh Business Group on Health (PBGH) commissioned a study that compares, among other indicators, the number of…

March 13, 2012

HCI3 Improving Incentives Issue Brief – Analysis of Medicare and Commercial Insurer-Paid Total Knee Replacement Reveals Opportunities for Cost Reduction

Objective: To understand the variation in episode costs in total knee replacement (TKR) in Medicare and commercially insured patients and to estimate potential savings achievable with a bundled payment program. Patients and Methods: We performed a retrospective analysis of claims…

February 23, 2012

What is an Episode of Care Engine?

Recently in an article on episode of care purchasing written for the New England Journal of Medicine, Rob Mechanic of Brandeis University, noted that several software firms “are developing ‘engines’ to automatically convert fee-for-service claims into episode-based payments”1. He also…

February 10, 2012

{Then} {Now}

That Was Then, This Is Now

In 2006, the Commonwealth Fund and the Robert Wood Johnson Foundation (RWJF) funded the development of the PROMETHEUS Payment methodology, a patient-centered episode of care logic that bundles payment around a particular condition or procedure. In addition to development, RWJF…

November 10, 2011

Guidelines for Benefits Operations in Episode of Care Contracting

As PROMETHEUS pilot sites have expanded, and in particular, with the recent Center for Medicare and Medicaid Innovation (CMMI) push into bundled or episode payment, questions about how benefits should be operated have come to the fore. It is easy…

October 7, 2011

The History of the Development of the Prometheus Payment Model Defined Potentially Avoidable Complications.

In 2006 the Prometheus Payment Design Team convened a series of meetings with physicians that had been organized in Clinical Working Groups. These Groups focused on Cancer, Cardiac, Chronic, Orthopedic and Preventive care. Their task was to select a starter…

September 28, 2011

Suggested Data Warehouse Fields for Robust Analysis

HCI3 is working with health plans throughout the country on pilot implementations to test the validity of the Evidence-informed Case Rate (ECR) models, as a means to fairly and equitable price health care services and encourage physicians, hospitals and all…

September 28, 2011

Reliability of Prometheus PAC (Potentially Avoidable Complications) Measures

Potentially avoidable complications (PACs) for patients with one or more chronic illness include events such as emergency department visits and hospitalizations. For patients hospitalized with an acute medical illness such as AMI, pneumonia or stroke, these events may occur during…

September 28, 2011

Prometheus Pilot: Policy Decisions

As the pilot site moves closer to implementation, a progressive “glide path” has emerged to take provider reimbursement from the current fee-for-service mode to bundled payment or case rate reimbursement for patient-centered episodes of care. Part of the initial implementation…

September 28, 2011

PROMETHEUS PAYMENT MODEL

The PROMETHEUS Payment model is an ambitious attempt at creating a patient- centered payment for health care services that would split apart technical and probability risks (currently compressed and indistinguishable in either fee for service or capitation payments) and assign…

September 28, 2011

PROMETHEUS Newsletter: Issue 7

October 2010

As we enter the home stretch of our implementation grant from the Robert Wood Johnson Foundation (RWJF) we here at PROMETHEUS Payment are taking stock of the lessons we have learned thus far. As the PROMETHEUS model matures, we are…

September 28, 2011

What’s the Most Rational and Sustainable Pathway To a New Health Care Payment System?

REWARDING EXCELLENCE, CONTROLLING COSTS: a realistic blueprint for fundamental change. Everyone knows the U.S. must transform the way it pays for health care. The question, of course, is how. We believe PROMETHEUS Payment® is the model that best addresses the…

September 28, 2011

Sustaining the Medical home:

How Prometheus Payment® Can Revitalize Primary care

As U.S. policymakers debate various approaches to reform the nation’s ailing health care system, efforts to improve quality and reduce costs have never received more attention. One potential solution that is gaining support is to restructure primary care practices to…

September 28, 2011

Prometheus Evidence-informed Case Rate (ECR) Contracting Strategies and Guidelines for Health Plans

Health Plans using the Prometheus ECRs to contract with providers are faced with a number of issues. This guide is intended to address these issues and provide some strategies and suggested guidelines for addressing them.…

September 28, 2011

PROMETHEUS NEWSLETTER: ISSUE 6

June 2010

With the passage of the Patient Protection and Affordable Care Act (PPACA), it is a whole new dawn for those of us working in the world of payment reform and PROMETHEUS Payment. From our partners and pilot sites to the…

September 28, 2011

Provider-Payer Contract Amendment Template Principles

This document and the attached contract amendment template (the “Template”) have been created as a foundation for Payors and Providers to modify and customize for the purpose of creating an appropriate amendment to their existing Provider Participation Agreement. This document…

September 28, 2011

The Quality-Payment Connection: Is There Really Anything New?

Today's new calls for quality improvement with containment of escalating costs will only intesify as the effects of the economic crisis filter throughtout the economy.  But what is really so new about asking whether we are getting the right health…

September 28, 2011

Making PROMETHEUS Payment® Rates Real:

Ya’ Gotta Start Somewhere

The seeds of the PROMETHEUS Payment® model1 were sown with the first Design Team meeting in December 2004. A small group of experts and stakeholders from multiple disciplines and with diverse skill sets came together with one goal—to design an…

September 28, 2011

PROMETHEUS Payment: Better Quality and a Better Business Case

Frustration with the quality of care provided by the American health care system has motivated a raft of new initiatives throughout the country. Medicare’s “voluntary” hospital reporting program to which Congress attached financial penalties for noncooperation,1 the purchasing principles of…

September 28, 2011

What Every Employer Must Do Now to Drive Down Health Care Costs

Know your numbers. Three key metrics can make a big difference—and you have plenty of power to improve them. If you had to spend an extra $4,000 on every person covered by your company’s health plan, what would that do…

September 28, 2011

Better Measures, Easier Reporting:

How one provider recognition program evolved over time to the benefit of all stakeholders.

How one provider recognition program evolved over time to the benefit of all stakeholders.…

September 28, 2011

Prometheus Payment Model

Application to Hip and Knee Replacement Surgery

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for- service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical…

September 28, 2011