Library

Library

Bending the Curve Through Health Reform Implementation

QUALITY. INDEPENDENCE. IMPACT.

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

Additional Facility Costs due to PACs: Example Calculation

The Additional facility costs due to PACs calculation is used to separate the cost associated with the typical hospital stay and cost associated with the PAC.…

September 28, 2011

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

Bariatric Surgery (BARI) ECR Playbook

ECR Definition Summary

Bariatric Playbook/ECR Definition Summary…

September 27, 2011

Asthma ECR Playbook

ECR Definition Summary

Asthma Playbook/ECR Definition Summary…

September 27, 2011

Acute Myocardial Infarction (AMI) ECR Playbook

ECR Definition Summary

AMI Playbook/ECR Definition Summary …

September 27, 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

Accountable “Care Organization” or “Accountable Care” Organization

The Patient Protection and Affordable Care Act (ACA) includes a number of delivery system and payment reform initiatives that hold much promise for bending the cost curve. The legislation provides for mandatory programs like value based purchasing, pilot and demonstration…

September 27, 2011

The American Board of Internal Medicine (ABIM) FAQs

The American Board of Internal Medicine (ABIM) diabetes PIM pathway. This is available to all internists. A Practice Improvement Module (PIM) is typically completed as part of Maintenance of Certification; the data you gather for that process can be used…

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 Payment ECR Instruction Book

Version 3.6 for PC - May, 2011

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 Incentives Improvement Institute,…

September 23, 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

ECR Instruction Guide Addendum for the CMMI Bundled Payment Pilot

The PROMETHEUS ECR analytics can be used to assist prospective CMMI Bundled Payment Pilot sites in selecting their DRG(s) of choice and creating a bundled episode price for each DRG selected. The following will help to instruct those running Medicare claims data through the SAS analytics…

September 16, 2011

How Hospitals, Physicians, and Others Can Get Organized to Participate in CMS’ Bundled Payment Pilot

Seeking to improve patient care through payment innovation, the federal Centers for Medicare & Medicaid Innovation (CMMI announced its Bundled Payments for Care Improvement initiative in August. Model 2 of this initiative offers a fairly flexible approach to hospital-physician collaboration…

September 16, 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