Medicare Spends Less Than Private Insurers On Knee Replacements

The federal government spends 14 percent less than private insurers for knee replacement surgery and its related costs, even though Medicare patients are older and twice as likely to be readmitted to the hospital, a research paper released this week…

March 9, 2012

An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers—those who offer higher quality and…

March 9, 2012

Medicare: Lack of Price Transparency May Hamper Hospitals’ Ability to Be Prudent Purchasers of Implantable Medical Devices

GAO: Report to the Chairman, Committee on Finance, U.S. Senate

Why GAO Did This Study — Implantable medical devices (IMD)— including a variety of cardiac and orthopedic devices provided to Medicare beneficiaries in inpatient or outpatient hospital settings—represent a significant share of hospitals’ supply costs. Hospitals purchase IMDs directly from manufacturers…

February 24, 2012

HCI3 Improving Incentives Issue Brief – Analysis of Medicare and Commercial Insurer-Paid Total Knee Replacement Reveals Opportunities for Cost Reduction

Objective: To understand the variation in episode costs in total knee replacement (TKR) in Medicare and commercially insured patients and to estimate potential savings achievable with a bundled payment program. Patients and Methods: We performed a retrospective analysis of claims…

February 23, 2012

Reforming Payments to Healthcare Providers

The Key to Slowing Healthcare Cost Growth While Improving Quality?

The seemingly intractable debate about how to slow the growth of healthcare costs in the United States and elsewhere has traditionally boiled down to efforts to limit prices and quantities directly. In public healthcare programs, the focus in the United…

February 23, 2012

Sources of Regional Variation in Medicare Part D Drug Spending

Sources of regional variation in spending for prescription drugs under Medicare Part D are poorly understood, and such variation may reflect differences in health status, use of effective treatments, or selection of branded drugs over lower-cost generics… We analyzed 2008…

February 10, 2012

Medicare: Lack of Price Transparency May Hamper Hospitals™ Ability to Be Prudent Purchasers of Implantable Medical Devices

GAO: Report to the Chairman, Committee on Finance, U.S. Senate

From 2004 through 2009, expenditures for hospital IMD procedures increased from $16.1 billion to $19.8 billion, an increase of 4.3 percent per year—a rate equal to that of Medicare spending for other hospital procedures. While cardiac and orthopedic procedures accounted…

February 10, 2012

What is an Episode of Care Engine?

Recently in an article on episode of care purchasing written for the New England Journal of Medicine, Rob Mechanic of Brandeis University, noted that several software firms “are developing ‘engines’ to automatically convert fee-for-service claims into episode-based payments”1. He also…

February 10, 2012

Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was…

February 8, 2012

Fundamental Reform of Payment for Adult Primary Care

Comprehensive Payment for Comprehensive Care

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment…

February 8, 2012

The Patient Centered Medical Home

History, Seven Core Features, Evidence and Transformational Change

The Patient Centered Medical Home (PCMH) is a model of care articulated by principles that embrace the aspirations of the Institute of Medicine, the design of the Future of Family Medicine new model of care and The Wagner Care Model,…

February 8, 2012

Reducing potentially avoidable complications in patients with chronic diseases

The Prometheus Payment approach.

OBJECTIVE (OR STUDY QUESTION): To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness. DATA SOURCES/STUDY SETTING: A claims database of 3.5 million commercially insured members under age…

February 7, 2012

Hospital Perspectives on Reducing and Preventing Readmissions

As hospital-acquired infections (HAIs) are drawing intense scrutiny from regulators and payers, hospitals are finding that practicing careful case management can help prevent HAIs and patient readmissions. Successful strategies include discharge planning, transition plans for home care and tertiary care,…

January 3, 2012

OrthoChoice Brief

Initial Results Promising for Bundled Payment Model in Stockholm

In 2009, a bundled payment model was implemented for total hip and knee replacement on a health system level in Stockholm. In 2010, a joint study was set up in collaboration between the Stockholm County Council, Karolinska Institutet and the Institutet for…

December 14, 2011

Rockford Prometheus Pilot Case Study

The Rockford PROMETHEUS pilot was one of the original Robert Wood Johnson Foundation-funded implementation sites, which aimed to operationalize the PROMETHEUS model to address the range of issues. The objective of the pilot was to test the validity of the…

November 18, 2011

{Then} {Now}

That Was Then, This Is Now

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…

November 10, 2011

Guidelines for Benefits Operations in Episode of Care Contracting

As PROMETHEUS pilot sites have expanded, and in particular, with the recent Center for Medicare and Medicaid Innovation (CMMI) push into bundled or episode payment, questions about how benefits should be operated have come to the fore. It is easy…

October 7, 2011


Pilot Assessment and Implementation Toolkit

Welcome! This toolkit is designed to provide the information you need to gain a solid understanding of the PROMETHEUS Payment model, consider the potential benefits of a pilot implementation and take action. It is meant for use by local health…

September 28, 2011

The Potential of HIEs as Infomediaries

For more than 40 years, various health services researchers have noted the many distortions in the American healthcare economy that produce massive information assymetries and almost near opacity in the medical services delivery market.This paper comments on the potential of…

September 28, 2011

The History of the Development of the Prometheus Payment Model Defined Potentially Avoidable Complications.

In 2006 the Prometheus Payment Design Team convened a series of meetings with physicians that had been organized in Clinical Working Groups. These Groups focused on Cancer, Cardiac, Chronic, Orthopedic and Preventive care. Their task was to select a starter…

September 28, 2011

Analyzing Sources of Variation within Episode Costs:

The objective of this report is to summarize the results of a comprehensive data analysis and identify opportunities for improvement both in terms of 1) lowering costs and 2) improving quality of care using the unique features of the Prometheus…

September 28, 2011

Bridges to Excellence (BTE) in Practice

SwedishAmerican Medical Group, Rockford, IL

Headquartered in Rockford, Illinois, SwedishAmerican Health System serves 12 counties in northern Illinois and southern Wisconsin.…

September 28, 2011

Suggested Data Warehouse Fields for Robust Analysis

HCI3 is working with health plans throughout the country on pilot implementations to test the validity of the Evidence-informed Case Rate (ECR) models, as a means to fairly and equitable price health care services and encourage physicians, hospitals and all…

September 28, 2011

Reliability of Prometheus PAC (Potentially Avoidable Complications) Measures

Potentially avoidable complications (PACs) for patients with one or more chronic illness include events such as emergency department visits and hospitalizations. For patients hospitalized with an acute medical illness such as AMI, pneumonia or stroke, these events may occur during…

September 28, 2011

Prometheus Pilot: Policy Decisions

As the pilot site moves closer to implementation, a progressive “glide path” has emerged to take provider reimbursement from the current fee-for-service mode to bundled payment or case rate reimbursement for patient-centered episodes of care. Part of the initial implementation…

September 28, 2011