Library

Library

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

Prometheus Pilot Site Learning Forum: Analytics

Dec 20, 2010

Agenda • Overview EvidenceInformedCaseRates(ECR)Construct SourcesofVariationinEpisodeCosts ChronicCareECRPatterns Inpatient&OutpatientECRPatterns ProviderLevelAnalysis Observations/Recommendations…

September 28, 2011

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

Prometheus Implementation Timeline and Estimation of Resource: Best and Worse Case Scenarios

September 28, 2011

ECR® Manual

Version 3.5.2

Evidence-Informed Case Rates®, or ECRs®, are patient-specific, severity-adjusted bundles of services during a defined time period for the treatment of specific conditions. ECR® methodology was developed by the Prometheus Payment design team and is the property of the Health Care…

September 28, 2011

ECR® Instruction Book

Version 3.5.2 (UNIX version)

September 28, 2011

ECR® Instruction Book Supplement

Data Extract Specifications Version 3.5.2

This document is intended for use by health plans, employers, and other entities (called Data Submitters) who wish to send their claims data to Prometheus for ECR analysis in a format other than SAS. Data Submitters may provide data extracts…

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

Pneumonia ECR Playbook

ECR Definition Summary

September 28, 2011

Coronary Angioplasty (PCI) ECR Playbook

ECR Definition Summary

September 28, 2011

Statement of Commitment for Payers

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

HCI3® ECR® Analysis Tool Opportunity Report

This Opportunity Report presents your customized results from the ECR® Analysis tool with comparisons to national and state benchmarks. The report provides a snapshot of your current healthcare spending on specific ECR ® clinical areas and highlights the savings opportunities…

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

Low-Risk Pregnancy and Delivery (PREG) ECR Playbook

ECR Definition Summary

September 28, 2011