PROMETHEUS Payment®: What’s the Score?

PROMETHEUS Payment®: What’s the Score?

How Scores Determine Provider Payment

The PROMETHEUS Payment® model is explicitly designed to pay providers to deliver what science says patients should receive for their specific constellation of clinical problems associated with a condition. The maximum payment amount for a provider is based upon an Evidence-informed Case Rate® (ECR). Whether the provider will realize the full potential for payment depends on the scores that provider earns under the model’s comprehensive scorecard. To create a very clear incentive for clinical collaboration, the final scores depend 70% on what the provider does and 30% on what every other provider treating that patient for that condition has done—whether under the ECR or not. The scoring system is an essential element of what makes the PROMETHEUS Payment® model different from other payment systems as well as different from typical pay-for-performance models, even though it uses many of the same measures that pay-for-performance programs use today.

The workings of the PROMETHEUS® scorecard have not been fleshed out until relatively recently. Now it is time to explain the theory of the scoring and its development. This paper describes how we got to the current scoring approach, the principles of scoring, the sources of the measures, how scores are calculated, and the impact of the scores on payment. It should be noted, however, that as with much of the conceptual work on PROMETHEUS Payment®, we expect that multiple aspects of the scoring will be refined as we implement the program in pilot sites and with other collaborators. Still further, it is beyond the scope of this first iteration to explain all the possible permutations in scoring. The purpose of this paper is to introduce and elucidate the basics of scoring. So, let’s get started…