New Report Shows Progress in Implementing Bundled Payments Across the U.S.
PROMETHEUS Payment pilots now live in several states including Illinois, Michigan, New Jersey, North Carolina and Pennsylvania
WASHINGTON — November 11, 2011 — The non-profit Health Care Incentives Improvement Institute™, Inc. (HCI3™) released a new report on the development of the organization’s PROMETHEUS Payment® model, a patient-centered episode of care that bundles payment around a particular health condition or procedure. The overview, “That was then, this is now,” details key lessons learned and next steps for pilot site implementations amidst the ever-changing health care landscape.
“The evidence that bundled payments work is overwhelming,” said Francois de Brantes, HCI3 executive director. “It’s one of the reasons why the Center for Medicare and Medicaid Innovation Center launched its Bundled Payment pilot. And while technical barriers slowed the initial efforts, there are now operational statewide implementations — complete with provider contracts and bundled payments — in North Carolina and California.”
The significant speed-up in implementations is due to several factors. First, the national discussion around increased costs of care is causing providers and payers (both public and private) to move away from volume-based payments such as fee-for-service. Second, new technologies have emerged to support payers and providers in implementing bundled payments. In particular, claims accounting and payment tools such as the ones developed by MedAssets and Trizetto, are providing real-time reports to payers on episodes triggered and claims incurred against episode budgets. Original PROMETHEUS Payment pilot sites such as Grand Rapids, Mich., and Rockford, Ill., are using these technological solutions today.
Development of PROMETHEUS model
In 2006, The Commonwealth Fund and the Robert Wood Johnson Foundation (RWJF) funded the development of the PROMETHEUS Payment methodology with the goal of coordinated care among physicians, hospitals and other providers. The PROMETHEUS model was designed to provide quality care with improved care coordination at competitive pricing and is based on delivering value-driven health care with strong incentives for clinical collaborations and efficiency.
In addition to development, RWJF also provided funding for a three-year implementation period, from 2007 to 2010, during which the PROMETHEUS model would be pilot tested in various health care markets across the country. Since then, implementations of the PROMETHEUS model have expanded from the original four pilot sites to several other sites. These new sites have benefited from the experience of the earlier ones and have been able to get to full operational implementation in a matter of months, not years.
New technologies are coming online to expand the PROMETHEUS model and other Bundled Payment implementations, and empower providers and payers to embark on value-based payment. Implementation sites will continue to expand as providers seeking to participate in the CMMI Bundled Payment pilot contract with private sector payers for similar bundles.
About Health Care Incentives Improvement Institute™, Inc.
The Health Care Incentives Improvement Institute, Inc. (HCI3®) is a not-for-profit multi-stakeholder umbrella organization for Bridges to Excellence® and PROMETHEUS Payment®. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. health care system. www.HCI3.org