Igniting Health Care Payment Reform

Igniting Health Care Payment Reform

A review of the PROMETHEUS Payment® approach describes the key components of a strategy to manage the rise in health care costs. Using common incentives and connecting payment to clinical practice guidelines and evidence-informed case rates can result in high quality health care at a reasonable cost.

Health care costs, which involve payments to hospitals, physicians and other health care providers, have been steadily increasing. The PROMETHEUS Payment approach is an attempt to address the rise in health care costs while maintaining high quality patient-centered care.

The current issue brief details the PROMETHEUS Payment approach.

Key Findings:

Key to PROMETHEUS is employment of common incentives and linking payment to clinical practice guidelines (CPGs) and outcomes.
The Evidence-informed Case Rate® (ECR) is the calculation of the amount providers are paid for following CPGs for specific conditions. ECRs consist of a base, a modification based on condition severity, a financial margin, and a “withhold” that is paid once quality of care is evaluated.

The Robert Wood Johnson Foundation (RWJF) committed $6.4 million so that PROMETHEUS could be piloted and evaluated in several communities, expand the set of ECRs, and develop a Scorecard that offered insight into the performance and price of health care.
PROMETHEUS aims to promote the value and quality of health care; decrease the administrative work of providers; and offer reasonable compensation for providers given scientifically-determined treatment for patients with specific conditions.

Michael Painter, a senior program officer at RWJF states,"this project has the potential to orient the health care payment system to the patient's perspective, and could become a powerful tool to help people choose high-value health care."

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