PROMETHEUS Implementation Toolkit

PROMETHEUS Implementation Toolkit

PROMETHEUS Implementation Toolkit

Brief Summary of Program and Goals

(click here to download a PDF of an older version of the Toolkit)

The PROMETHEUS Payment system is a package, or bundled fee payment system centered on a comprehensive episode of medical care that covers all patient services related to an illness, condition, or procedure. PROMETHEUS Payment addresses a full range of issues that can drive profound long-term, system-wide improvements including:

  • Fair compensation of providers – and rewarding excellence by allowing top performers to earn more,
  • Offering direct and powerful incentives for providers to deliver greater value and better outcomes,
  • Encouraging caregivers to work in teams, share information, and take collective responsibility for a patient’s health,
  • Providing a realistic framework to transform today’s fragmented and inefficient system into one that is far more integrated and accountable.

Pilot implementations are starting up in different parts of the country to test the validity of the Evidence-informed Case Rate® (ECR) models as a means to fairly and equitably price the care of patients and encourage physicians, hospitals and all other clinicians to actively collaborate in delivering effective and efficient care to each patient. Each site is working towards reducing the rate of potentially avoidable complications (PACs), controlling “typical” or expected costs, promoting a patient-centered environment, and helping providers act as a team.

Although there are a number of flexible ways to implement the PROMETHEUS ECR methodology, in most sites, incentives are offered to providers and health systems in the form of bonuses paid at the end of the year to those clinicians who come under their ECR budgets and deliver quality care to patients. Bridges to Excellence (BTE) Care Recognition Programs are an important aspect of PROMETHEUS implementations. Each implementation site selects one or more BTE Care Recognition Programs that support quality reporting for corresponding ECRs, and for which clinicians must submit clinical data. For pilot sites implementing procedural ECRs, many sites have created their own procedure-specific quality scorecards based off of various clinical guidelines being used in the industry.

For a pilot site to be launched, the active participation of at least one payer and the active participation of at least one provider organization are required. Ideal pilot sites include multiple provider organizations. One of the objectives of PROMETHEUS is to encourage physicians and hospitals to work together around the care of a patient, and to overcome the organizational barriers of siloed fee for service medicine. Below are links to descriptions of the steps it takes to launch an implementation, as well as tools to help in this endeavor. Also included are lessons that have been learned so far during the implementation process with our current pilot sites, which are are critically important to the success of PROMETHEUS.

 

STEPS TO LAUNCHING AN IMPLEMENTATION:

These steps do not necessarily have to be completed in the order they are given. In fact, since many of the steps can take some time to complete, HCI3 recommends that a pilot site work on many of these steps concurrently, after the leadership of participating organizations have a solid understanding of the PROMETHEUS methodology.

Preliminary Step: Initial data run

Step 1: Demonstration of Commitment by Leadership

Step 2: Engage Payers and Providers

Step 3: Define Pilot and Draft Contracts

Step 4: Launch Implementation