Newtown, CT – November 18, 2011
Rockford, IL, is one of three original PROMETHEUS pilot sites and today we report on findings from that implementation – Last week Health Affairs released a qualitative review of three implementation sites, relating the impressions of the evaluators, gleaned from a few phone interviews and a couple of site visits. This week we release a comprehensive qualitative and quantitative report on one site, with more to follow in the coming months. It describes in detail the challenges faced and the operational resolutions to these challenges. It provides both context and depth for anyone truly interested in understanding how to make implementations succeed and what pitfalls to avoid. And it also describes that, despite the challenges faced, there have been significant improvements. First, the increase in chronic care costs has moderated in the targeted episodes – it has flattened. Second, the two main health systems participating in the pilot have developed dashboards and other clinical improvement systems that have led to quality improvements. Third, the episode accounting engine has moved from an alpha to a fully functioning version that produces continuous reports on episodes triggered and costs incurred against them. This report is timely given the release of a study by the Commonwealth Fund showing that, in 2010, 62% of the U.S. population lived in states where health insurance premiums equaled 20% or more of earnings for a middle-income individual under age 65. In 2003, there were 13 states where annual premiums constituted less than 14% of the median (middle) income; by 2010, there were none.
What this means to you – Changing incentives changes the focus of the delivery system. The two health systems in Rockford improved the quality of the care delivered to all patients and that had a beneficial impact on the costs of care of certain chronic conditions for Rockford employers. While underlying use and price of care continues to rise at more than inflation, especially for chronic illness, the costs in Rockford have essentially flattened. That is the truth of payment reform. And while none of us would dispute that it's hard, we're also adamant that it's working and getting easier to implement every day. We've been working with these sites every day for three years, and today we share the results of that experience, not in a superficial way, but in a detailed and comprehensive way that no journal would publish because it takes too much space. While the agents of the status quo will focus on the sound bites and the misleading headlines, the change agents that work every day to improve the system can find the truth here.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.