Open Door Forum: Hospital Value-Based Purchasing

Fiscal Year 2013 Overview for Beneficiaries, Providers, and Stakeholders

CMS presentation that details the Hospital Value-Based Purchasing program

March 11, 2013

How does Medicare value-based purchasing work?

Issue Brief that describes Medicare's Value-Based Purchasing Program, created via the Affordable Care Act, which aims to reward hospitals that meet specific quality standards

March 11, 2013

HCI3 Improving Incentives Issue Brief: Tracking Transformation in US Health Care

How Do You Know You're Making Progress?

How do you know you’re making progress? That’s the question that everyone in health care should be asking, and be able to answer. In this Issue Brief we propose a few metrics that, collectively, should give us and others a…

January 17, 2013

It’s the Incentives, Stupid!

Why Rotten Incentives Continue to Screw Up Health Care

Healthcare is plagued by many things, but none is worse than the incentives that drive physician, hospital and patient behaviors. This book is a compilation of 18 months of reflections on those incentives and offers some solutions to the problems…

October 19, 2012

HCI3 Improving Incentives Issue Brief: Designing the BPCI for Success

CMMI Bundled Payments for Care Improvement Requires Design Changes to Ensure Pilot Success

Objective: Examine the variation in costs within certain episodes of care to better quantify the risks and benefits to providers participating in the CMMI Bundled Payments for Care Improvement (BPCI). Methods: We performed a retrospective analysis of claims data using…

August 29, 2012

Hospitals on the Path to Accountable Care

Highlights from a 2011 National Survey of Hospital Readiness to Participate in an Accountable Care Organization

ABSTRACT: Accountable care organizations (ACOs) are forming in communities across the country. In ACOs, health care providers take responsibility for a defined patient popu- lation, coordinate their care across settings, and are held jointly accountable for the quality and cost…

August 17, 2012

Accountable Care Strategies

Lessons from the Premier Health Care Alliance's Accountable Care Collaborative

Abstract: Accountable care organizations (ACOs)—groups of providers that agree to take collective responsibility for delivering and coordinating care for a designated population—are being promoted as a means to improve health and health care while containing costs. This report shares the…

August 17, 2012

Technical Appendix 1

The warranty allowance model division between flat fee and proportional rate

Editor’s Note: This online data supplement contains supplemental material that was not included with the published article by Francois de Brantes and colleagues, “Should Health Care Come With A Warranty?” Health Affairs 28, no. 4 (2009): w678–w687 (published…

June 20, 2012

Igniting Health Care Payment Reform

A review of the PROMETHEUS Payment® approach describes the key components of a strategy to manage the rise in health care costs. Using common incentives and connecting payment to clinical practice guidelines and evidence-informed case rates can result in high…

June 20, 2012

What are Prometheus Payment Evidence-Informed Case Rates (ECRs)?

Predetermined budgets that are bundled to cover comprehensive, evidence-based, personalized care in treating a given condition.

From fee-for-service, to capitation, to episode-based models—proposals for paying providers in the United States’ health care system have come in all shapes and sizes over the decades. Tried and tested payment systems have all purported to be effective in addressing…

June 20, 2012

HCI3 Improving Incentives Issue Brief: Bundled Payment Across the U.S. Today

Status of Implementations and Operational Findings

Health policy discussion across the United States during the past few years has placed significant attention on the adverse effects of fee-for-service payment, the predominant method of paying for health care services in the country. Feefor- service payment has been widely criticized for financially motivating providers…

May 25, 2012


Will the Latest Payment Trend Improve Care?

Pay-for-Performance programs are now firmly ensconced in the payment systems of US public and private insurers across the spectrum. More than half of commercial health maintenance organizations are using pay-for-performance, and recent legislation requires Centers for Medicare & Medicaid Services…

May 3, 2012

HCI3 Improving Incentives Issue Brief: Cutting Inpatient Days and ER Visits

Study Finds Improved Focus on Population Management and Chronic Illness Cuts Inpatient Days and Emergency Room Visits

Objective: To study the cost and utilization performance of primary care physicians (PCPs) with and without a patient-centered medical home (PCMH) designation or a Bridges to Excellence (BTE) Diabetes Recognition. Methods: We performed a retrospective analysis of claims data using…

May 2, 2012

Delineating Episodes of Medical Care

The original idea for a medical episode is laid out here.  The usual measures used to document use of medical services were found insufficiently penetrating in a utilization study conducted by the authors. A useful measure which gives meaning and…

April 25, 2012

Key Design Elements of Shared-Savings Payment Arrangements

August 2011 Issue Brief

Shared savings is a payment strategy that offers incentives for providers to reduce health care spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts. The concept has attracted…

April 19, 2012

PROMETHEUS: New Payment System, New Keys to Success

Criticism of the predominant payment systems in the United States is rampant. From the Institute of Medicine's call for payment reform in order to improve quality, to physician dissatisfaction with administrative burdens, to employer concerns about escalating costs, no one…

April 10, 2012

In Common Cause for Quality, Part 1

New Hospital-Physician Collaborations

The call for improved quality dominates the health care landscape. The Institute of Medicine’s Crossing the Quality Chasm, a dramatic increase in transparency, the advent of pay for performance and the 100,000 Lives Campaign are pressing all types of health…

April 10, 2012

In Common Cause for Quality Part 2

PROMETHEUS Payment® and Principles of Engagement

Quality demands alone ought to motivate hospitals to seek ways to collaborate more effectively with physicians. But the most significant lever to better hospital-physician relationships might be a different payment system. Pay for performance, while a positive development, is generally…

April 10, 2012

The Prometheus Payment Program: A Legal Blueprint

Pay for performance (P4P) programs are sweeping the country in both public and private health insurance. Responding to the Institute of Medicine's call for new payment models to really advance quality, these initiatives are typically designed to motivate physicians to…

April 10, 2012

Can Health Care Come With a Warranty?

From the time I was in grade school until just a few years ago, my parents owned a series of small neighborhood businesses. The first was a corner convenience store in an Italian neighborhood; eventually they traded up to three…

April 10, 2012

The PROMETHEUS Model: Bringing Healthcare into the Next Decade

From: Annals of Health Law Advance Directive p274-284

The United States’ current healthcare system has long been structured to emphasize the quantity of health care over the quality of health care. Such a focus of quantity is evident in the fee-for service structure, where providers are paid a specified…

April 10, 2012

Transitioning to Value

PROMETHEUS Payment Pilot Lessons

As the healthcare system begins to transition from volume-based to value-based payment, industry stakeholders are experimenting with payment models that can effectively align incentives to generate high-quality outcomes while reducing the cost of care. Participants in a pilot of the…

April 9, 2012

Episode of Care Analysis Reveals Sources of Variations in Costs

Objectives: To understand and reveal the under­ lying sources of inter­ and intraplan variation in a selected number of chronic and procedural episodes. Study Design: Analysis of allowed claims from 9 regional health plans covering commercially insured populations in different…

April 9, 2012

Evaluating and Negotiating Emerging Payment Options

This “how-to” manual is intended to help physicians who are considering transitioning from fee-for-service payment to risk-based reimbursement. It covers the nuts and bolts of payment systems based on a physician’s ability to stay within a specified budget for health…

March 15, 2012

HCI3 Improving Incentives Issue Brief: Hospital Bed Supply and Hospitalizations

A Tale of Four Cities

Objective: To understand the relationship between the supply of hospital beds and the frequency of hospitalizations in four comparable U.S. cities. Methods: The Pittsburgh Business Group on Health (PBGH) commissioned a study that compares, among other indicators, the number of…

March 13, 2012