Traditional fee-for-service costs
In a traditional fee-for-service payment system, the overall claims costs for one year of Tom’s routine care totals $6,700—assuming no complications.
PROMETHEUS Payment budget
Under the PROMETHEUS model, the treatment budget is calculated as a patient-specific “Evidence-informed Case Rate” (ECR®). An ECR includes all covered services related to the care of a single illness or condition, bundled across all providers. The ECR is also risk- adjusted to account for the severity and complexity of the patient’s condition, and includes an allowance for potentially avoidable complications (PACs). If complications occur, this portion of the budget offsets the costs of corrective treatment. But if providers can reduce or eliminate PACs, they keep the allowance as a bonus.