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In 2006, the Commonwealth Fund and the Robert Wood Johnson Foundation (RWJF) funded the development of the PROMETHEUS Payment methodology, a patient-centered episode of care logic that bundles payment around a particular condition or procedure. In addition to development, RWJF also provided funding for a 3-year implementation period, from 2007 to 2010, during which the PROMETHEUS model would be pilot tested in various healthcare markets across the country. Since then, implementations of the PROMETHEUS model have expanded from the original four pilot sites to several other sites. The following report provides an update on the progress of PROMETHEUS Payment amidst the ever-changing healthcare landscape, and details key lessons learned via the pilot site implementations.