Library

Library

Rockford PROMETHEUS Pilot Scope and Evaluation

Pilot Site Geography The geographical center of the Rockford PROMETHEUS pilot is, of course, Rockford, IL. However, the extent of the Employer’s Coalition on Healthcare (ECOH) provider network and member employers covers a fairly large area roughly dissected by the…

September 28, 2011

PROMETHEUS PAYMENT MODEL

The PROMETHEUS Payment model is an ambitious attempt at creating a patient- centered payment for health care services that would split apart technical and probability risks (currently compressed and indistinguishable in either fee for service or capitation payments) and assign…

September 28, 2011

PROMETHEUS Newsletter: Issue 7

October 2010

As we enter the home stretch of our implementation grant from the Robert Wood Johnson Foundation (RWJF) we here at PROMETHEUS Payment are taking stock of the lessons we have learned thus far. As the PROMETHEUS model matures, we are…

September 28, 2011

What’s the Most Rational and Sustainable Pathway To a New Health Care Payment System?

REWARDING EXCELLENCE, CONTROLLING COSTS: a realistic blueprint for fundamental change. Everyone knows the U.S. must transform the way it pays for health care. The question, of course, is how. We believe PROMETHEUS Payment® is the model that best addresses the…

September 28, 2011

Sustaining the Medical home:

How Prometheus Payment® Can Revitalize Primary care

As U.S. policymakers debate various approaches to reform the nation’s ailing health care system, efforts to improve quality and reduce costs have never received more attention. One potential solution that is gaining support is to restructure primary care practices to…

September 28, 2011

Prometheus Evidence-informed Case Rate (ECR) Contracting Strategies and Guidelines for Health Plans

Health Plans using the Prometheus ECRs to contract with providers are faced with a number of issues. This guide is intended to address these issues and provide some strategies and suggested guidelines for addressing them.…

September 28, 2011

PROMETHEUS® IN PRACTICE

Potential cost savings and bonuses for Tom's routine care

Traditional fee-for-service costs In a traditional fee-for-service payment system, the overall claims costs for one year of Tom’s routine care totals $6,700—assuming no complications. PROMETHEUS Payment budget Under the PROMETHEUS model, the treatment budget is calculated as a patient-specific “Evidence-informed…

September 28, 2011

PROMETHEUS NEWSLETTER: ISSUE 6

June 2010

With the passage of the Patient Protection and Affordable Care Act (PPACA), it is a whole new dawn for those of us working in the world of payment reform and PROMETHEUS Payment. From our partners and pilot sites to the…

September 28, 2011

PROMETHEUS® IN PRACTICE

Potential cost savings and bonuses for Ron's bypass surgery

Traditional fee-for-service costs Under a fee-for-service payment system, the hospital is paid $47,500 for Ron’s bypass procedure. In addition, all professional services for performing the procedure and providing care, including surgeon fees, cost $15,000. The complications caused by Ron’s uncontrolled…

September 28, 2011

PROMETHEUS® IN PRACTICE

Potential cost savings and bonuses for Karen's knee replacement

Traditional fee-for-service costs Under a fee-for-service payment system, assuming no complications, Karen’s knee replacement surgery would likely cost $24,000. Of course, there is a great deal of variability based on regional payment standards, what services are performed, and whether there…

September 28, 2011

PROMETHEUS® IN PRACTICE

Potential cost savings and bonuses for Charles' CHF treatment

Traditional fee-for-service costs Under a fee-for-service payment system, Charles’ ED visit, hospital stay and all associated lab tests and radiology exams cost a total of $11,228. This is in addition to his earlier ED visit, which cost $2,125. Charles is…

September 28, 2011

Provider-Payer Contract Amendment Template Principles

This document and the attached contract amendment template (the “Template”) have been created as a foundation for Payors and Providers to modify and customize for the purpose of creating an appropriate amendment to their existing Provider Participation Agreement. This document…

September 28, 2011

The Quality-Payment Connection: Is There Really Anything New?

Today's new calls for quality improvement with containment of escalating costs will only intesify as the effects of the economic crisis filter throughtout the economy.  But what is really so new about asking whether we are getting the right health…

September 28, 2011

Making PROMETHEUS Payment® Rates Real:

Ya’ Gotta Start Somewhere

The seeds of the PROMETHEUS Payment® model1 were sown with the first Design Team meeting in December 2004. A small group of experts and stakeholders from multiple disciplines and with diverse skill sets came together with one goal—to design an…

September 28, 2011

PROMETHEUS Payment: Better Quality and a Better Business Case

Frustration with the quality of care provided by the American health care system has motivated a raft of new initiatives throughout the country. Medicare’s “voluntary” hospital reporting program to which Congress attached financial penalties for noncooperation,1 the purchasing principles of…

September 28, 2011

The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary

THE LEARNING HEALTH SYSTEM SERIES ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE THE HEALTHCARE IMPERATIVE Lowering Costs and Improving Outcomes Workshop Series Summary…

September 28, 2011

Excellence in Chronic Care Management Program

Improve care, decrease expenses across six major conditions

The Excellence in Chronic Care Management program encompasses six chronic conditions: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, asthma, hypertension, and coronary artery disease (CAD). This program measures the quality and cost of care delivered in physician…

September 28, 2011

Raising the State of Care: A Custom Program to Target

six chronic illnesses and reward top-performing doctors.

By reducing potentially avoidable complications just 6%, this statewide benefits plan could save $10 million a year.…

September 28, 2011

How We’re Helping a Large Department of Health

fight back against avoidable complications.

To improve resident health and the community’s finances, we designed a scorecard that bundles a variety of measures into one robust performance assessment.…

September 28, 2011

Piloting PROMETHEUS®: Employers, Plans and Physicians

working together to reward greater quality and value.

Real payment reform won’t happen overnight. But for one employer coalition, a three-year pilot shows a promising way forward.…

September 28, 2011

What Every Employer Must Do Now to Drive Down Health Care Costs

Know your numbers. Three key metrics can make a big difference—and you have plenty of power to improve them. If you had to spend an extra $4,000 on every person covered by your company’s health plan, what would that do…

September 28, 2011

Better Measures, Easier Reporting:

How one provider recognition program evolved over time to the benefit of all stakeholders.

How one provider recognition program evolved over time to the benefit of all stakeholders.…

September 28, 2011

HEALTH INFORMATION EXCHANGE: FROM START UP TO SUSTAINABILITY

TELEMEDICINE SPECIAL PROJECT GRANTS: CONNECTING COMMUNITIES FOR BETTER HEALTH

There is no silver bullet for achieving sustainability in health information exchange. As much as we would like to report a spectacular finding that eluded all others investigating the question of sustainability, it became more and more apparent as we…

September 28, 2011

Prometheus Payment Model

Application to Hip and Knee Replacement Surgery

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for- service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical…

September 28, 2011

Getting the Team Paid: How Medicare Physician Payment Rules Impede Quality

In 1998, the National Quality Roundtable proclaimed the pressing need to change the American health care system to deliver more reliable and better quality care. At its best, health care in the United States is superb. Unfortunately it is often…

September 28, 2011