Building a Bridge from Fragmentation to Accountability” The Prometheus Payment Model

In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction……

September 28, 2011

Bridges to Excellence (BTE) in Practice

Family Doctors, LLC, Swampscott, MA

Family Doctors, LLC, opened in 1948 and is now comprised of eight family medicine physicians, a gynecologist, three nurse practitioners, a registered dietician and a clinical psychologist. The staff manages upwards of 40,000 patient visits per year.…

September 28, 2011

ECR® Engine Overview

A tracking and accounting engine is required to make the PROMETHEUS Payment® Model operational. We can provide one, or help you develop your own.

The PROMETHEUS Payment® model is a reimbursement solution that rewards providers for coordinating and delivering high quality, efficient care. It packages payments around a comprehensive Episode of Care (EOC) for a single illness or condition. The costs of treatments are…

September 28, 2011

PROMETHEUS Payment ECR Contracting Strategies

Agenda Myth Busting Prospective vs. Retrospective Payment CFO’s Dilemma Changing the Unit of Account Health Plan as Financial Integrator ACOs and Medical Homes Negotiating Risk Corridors Product Development…

September 28, 2011

Should Health Care Come With A Warranty?

Many goods and services come with warranties; should health care? Analysis of one payment model shows promise and challenges.

How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persis- tent growth in health spending. Adding “warranties” to care is an innovation that…

September 28, 2011

Evidence-informed Case Rates: A New Health Care Payment Model

As a way to address the flaws of traditional payment methods, like fee-for service and capitation, the authors of this report suggest a new payment model, based on evidence- informed case rates (ECRs). Under this system, providers are paid a…

September 28, 2011

Evidence-Informed Case Rates: Paying for Safer, More Reliable Care

There is widespread dissatisfaction with the current modes of paying for health care. Created by Prometheus Payment, evidence-informed case rates (ECRs) are designed to create fair payments for all providers deliv- ering care to a patient for a particular condition.…

September 28, 2011

Proportion of patients with a chronic condition that have a potentially avoidable complication during a calendar year.

As part of the development of the Prometheus Payment model, we have developed and published in several peer‐reviewed papers1‐4 the impact of potentially avoidable complications (PACs) on total cost of care. Potentially avoidable complications for patients with one or more…

September 28, 2011

Healthcare Finance: What I See Clearly Can Be Scary

The CFO's Dilemma May 2011

The CFO’s Dilemma…

September 28, 2011

Bridges to Excellence (BTE) in Practice

Baughman Family Medicine, Harrisburg, PA

Baughman Family Medicine is a single physician practice providing care to patients in Harrisburg PA since 2000. Dr. Paul Baughman graduated in 1993 from Lycoming College and obtained his medical degree in Philadelphia at The Philadelphia College of Osteopathic Medicine.…

September 28, 2011

Bending the Curve Through Health Reform Implementation


Reducing health care spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While…

September 28, 2011

Proportion of Patients Hospitalized with AMI/Pneumonia/Stroke that have a Potentially Avoidable Complication (during the Index Stay or in the 30 ­day Post Discharge Period)

As part of the development of the Prometheus Payment model, we have developed and published in several peer‐reviewed papers1‐4 the impact of potentially avoidable complications (PACs) on total cost of care. We define PACs as events that may occur during…

September 28, 2011

A New Payment Model for Quality: Why Care Now?

Since the publication of Crossing the Quality Chasm, the quest for significantly improved health care quality for all Americans has been joined by a wide variety of stakeholders. Beginning with the Institute of Medicine, virtually all recent commentators on quality…

September 27, 2011

Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation

Programs that create incentives and rewards for physicians are rapidly expanding in scope and reach. …

September 27, 2011

PROMETHEUS Payment: Getting Beyond P4P

The failure of existing payment systems to produce optimal quality has been decried far and wide, perhaps most importantly by the Institute of Medicine, calling for a new payment system for the 21st century. Pay for performance (P4P) programs have…

September 27, 2011

PROMETHEUS Total Knee Replacement Implementation Toolkit

This document serves as an addendum to the PROMETHEUS Implementation Toolkit and reviews variations on how to implement a Total Knee Replacement (TKR) episode using examples from three TKR PROMETHEUS pilots (Plans A, B and C). Topics addressed include variations…

September 23, 2011

Bundled Payment Case Study

This document serves as a case study for a Bundled Payment Pilot that began in February 2011. In addition to generally providing a blueprint for implementing a Total Knee Replacement (TKR) Bundled Payment Pilot, this document will also provide some…

September 23, 2011

Impact of Price/Use on Total Premium Cost Growth 2001-2010

Ten Year % Increase in Price and Use

September 9, 2011

PROMETHEUS Payment: Better for Patients, Better for Physicians

Although pay for performance is a positive development in the history of quality improvement in this country, it is generally accepted that most pay-for-performance programs do not offer a sustainable business model. PROMETHEUS Payment is a new approach to provider…

August 25, 2011

PROMETHEUS Payment®: What’s the Score?

How Scores Determine Provider Payment

The PROMETHEUS Payment® model is explicitly designed to pay providers to deliver what science says patients should receive for their specific constellation of clinical problems associated with a condition. The maximum payment amount for a provider is based upon an…

August 2, 2011

What is Prometheus Payment?

An Evidence-Informed Model for Payment Reform

Ideas about how to pay providers to improve quality and reduce costs are ground zero for many current discussions about national health reform. A variety of solutions are being touted to correct the widespread deficiencies and increase value in our…

August 1, 2011