PROMETHEUS PAYMENT MODEL

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 responsibility for the former to providers and the latter to insurers. The payment model’s foundational element is an Evidence-informed Case Rate (ECR), which is a bundled price for a severity-adjusted, typical episode of care for any patient- provider-payer triad after an episode is triggered. Under grants from the Commonwealth Fund and the Robert Wood Johnson Foundation, we used a large national medical and pharmacy claims dataset consisting of over 4.5 million covered lives to model ECRs for 21 acute & chronic medical conditions and inpatient & outpatient procedures. Electronic medical records data or results of laboratory or radiology tests were not available to us.