PMPM Opportunity Estimator Spreadsheet

HCI3’s ECR® Per Member Per Month (PMPM) Opportunity Estimator is designed to show you the potential savings opportunities you could realize by reducing potentially avoidable complications (PACs) if you shifted from a fee for service (FFS) model to a PROMETHEUS Payment® model. The estimator does not require you to calculate any of your own data, all estimates are based on your number of covered lives and actual national benchmarks.

Potentially Avoidable Complications (PACs) are the non-typical services that are paid under fee-for-service when "defects" in care occur. They increase cost and decrease positive outcomes. For example, a poorly managed COPD patient may end up in the hospital; an ICU patient may develop an infection at the hospital. The savings opportunities are based on reducing your incidence of PACs. In particular we focus on the PACs associated with the 21 conditions for which Evidence-Informed Case Rates (ECRs®) have been defined in the PROMETHEUS Payment Model. PAC rates can never be reduced to zero, even with the best care, but by observing state and national PAC rate benchmarks, we can identify lowest, highest and average PAC rates actually achieved, and use those as target PAC rates for realistic reductions and, therefore, realistic potential savings.

PLEASE NOTE: This estimator is a rough assessment. Savings opportunities are calculated from national benchmarks. These benchmarks are based on data from actual claims paid and real plan members, but are not based on your unique data. HCI3 offers additional solutions, both as freeware and for licensees, to calculate more accurate savings opportunities, return on investment, and tools for calculating a full budget using your actual data.

The next step is to investigate our ECR Case Rate Opportunity Calculator which allows you to download a freeware version of the PROMETHEUS Payment ECR SAS Software (you will need a SAS license or third party support) and, from the outputs, create a snapshot of your spending and potential savings opportunities across multiple conditions. More information is available from the ECR Case Rate Opportunity Calculator section of our site.