The Prometheus Payment Program: A Legal Blueprint

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 improve their care but increasingly they also address hospitals. While there is some data that shows that P4P payments produce changed physician behavior in some measure, there are many questions as to how P4P can be sustained as a payment model.

Against this background, a new payment model has been developed to (1) confront the toxicities to optimal quality which are found in fee for service (FFS) and capitation payment modes, (2) respond to the IOM's call for a new approach, and (3) tackle, with new thinking, the limitations of today's P4P. PROMETHEUS PaymentTM is a model which has been two years in teh initial design. Provider payment Reform for Outcomes Margines Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability is expected to accomplish these goals by focusing on the values conveyed by its acronymic name. Pilot demonstrations will permit a practical analysis of both its limitations and pitfalls and what will make it better. To make PROMETHEUS Payment real, however, it will be necessary to create additional contractual relationships and a new legal context for its operation… More in full document below.