PROMETHEUS IMPLEMENTATIONS
HCI3 is currently working with several implementation partners throughout the country to pilot the PROMETHEUS Payment model.
The following four implementation sites have been funded by the Robert Wood Johnson Foundation: HealthPartners in Minnesota, Independence Blue Cross – Crozer Keystone Health System in Pennsylvania, Employers' Coalition on Health in Illinois and Priority Health – Spectrum Health in Michigan.
In addition, there are implementation sites with the New York State Health Foundation and the Colorado Health Foundation.
Please check back often for updates on PROMETHEUS implementation pilots.
HealthPartners, a non-profit health plan serving Minnesota and certain counties in surrounding states, was a very early adopter of PROMETHEUS, engaging as a pilot site in the summer of 2008 while PROMETHEUS was still under development. Because HealthPartners has a very well resourced internal IT and Quality Management team, they were interested in implementing PROMETHEUS aggressively and independently. HealthPartners took the algorithms from the PROMETHEUS open-source website, and configured the acute myocardial infarction (AMI) ECR themselves, since the PROMETHEUS automated programs and SAS packages were not built at that time. The PROMETHEUS team, however, closely collaborated in the effort with HealthPartners so that the underlying principles and concepts of PROMETHEUS were maintained. Although configuring the PROMETHEUS method in its early stages of development required a fairly intensive effort on their part, HealthPartners succeeded in contracting the AMI ECR in four of their premier networks for operation in plan year 2009. With the first year of PROMETHEUS payment concluded, HealthPartners is in a position to report on the success of their implementation. And now that PROMETHEUS has had two years of constant improvement with the SAS software that codes the underlying methodology, HealthPartners is currently running all ECRs against its full database with an eye towards using ECR PAC analysis as an augment to their already existing disease management programs. With the improvements PROMETHEUS has made to the ECR software, running PAC analysis has become much easier. HealthPartners' team is making a rigorous effort to investigate the outputs and to understand how PROMETHEUS ECRs can enhance their understanding of their high resource patients and to direct needed interventions better.
Independence Blue Cross – Crozer Keystone Health System (PA)
Independence Blue Cross (IBC), in partnership with Crozer-Keystone Health System is piloting two inpatient procedural ECRs: Hip Replacement and Knee Replacement. IBC initially decided to become engaged with the PROMETHEUS model because it offered a revenue or profit opportunity outside of the traditional unit cost increases. From IBC's perspective, the PROMETHEUS model also provided an opportunity for medical cost containment through continued collaboration of care while leveraging the PROMETHEUS team as an independent third party facilitator. From Crozer-Keystone's standpoint, the PROMETHEUS model offered a chance to get ahead of the payment reform curve, to encourage continued care coordination, and to allow for the system to distinguish itself from among its competitors in the marketplace.
Employers' Coalition on Health (Rockford, IL)
In partnership with the area's healthcare providers, the Employers' Coalition on Health (ECOH) in Rockford, IL has begun a three-year pilot to test PROMETHEUS Payment. At first, the focus is on improving management of three chronic conditions: diabetes, hypertension and coronary artery disease (CAD). Providers who follow well-established clinical guidelines and avoid PACs should generate savings, which will be pooled and distributed to top performing physicians and member companies. Goals of ECOH are to reduce PACs by 6% in Year 1. The coalition also seeks to promote a patient-centered environment and help physicians act in teams – without disrupting current operations. This pilot is designed to drive down costs and provide a powerful catalyst for change. It supports the coalition's mission to continuously improve the value of health care services to member companies, employees and their families. If the pilot proves successful, PROMETHEUS will be expanded to other chronic conditions, such as congestive heart failure, asthma, and chronic obstructive pulmonary disease.
Priority Health – Spectrum Health (MI)
The Priority Health-Spectrum Health implementation site has chosen to focus on quality improvement and the reduction of potentially avoidable complications in four chronic conditions and an inpatient procedure: Diabetes, Congestive Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Colon Resection. The site has organized itself into four different tracks, including Administrative and Financial, Clinical Delivery System, Data Collection and Informatics, and Communications and Public Relations.
The Administrative and Financial track will monitor the connection the health plan will employ with the Prometheus Engine, a claims tracking and financial accounting system that reconciles the actual cost of care against the predicted cost of care for any given ECR. Working in collaboration with the health plan, the hospital, and the medical group, members of this track will help to set the criteria and mechanisms by which financial rewards will be distributed.
The Clinical Delivery System track is working on a delivery system-wide initiative to improve care processes, streamline workflows, reduce administrative burdens and redundancy, and improve the quality of care patients receive. Although this initiative is much larger in scope, the implementation site will first focus on Diabetes, CHF, Asthma, COPD, and Colon Resection so as to be in line with the areas of focus for the Prometheus pilot.
The Data Collection and Informatics team will assess the current state of where and how clinical information is stored among the physician practices in the pilot. They will perform a gap analysis between the metrics that need to be captured for the purposes of the pilot and what is already in place in their current systems. These clinical quality data will ultimately need to be extracted and formatted so that they can be assessed by an independent third party performance assessor (e.g. Minnesota Community Measurement or IPRO) and incorporated in the comprehensive quality scorecard.
The Communications and Public Relations track will provide frequent updates on the current status of the pilot in the spirit of full transparency and keep the local community well-informed.
New York State Health Foundation
Rising health care costs continue to put pressure on state budgets across the nation. Faced with this reality, New York State, which has the highest per capita expenditures on Medicaid and the third highest total health care costs (both public and private) per capita among states, is looking for ways to bolster efforts to contain costs.
As a result, the New York State Health Foundation provided a two-year grant to the Health Care Incentives Improvement Institute Inc. in 2009. The objective of the grant is to establish partnerships with both commercial and public insurers across the state to launch two pilot tests for reimbursement using evidence-based case rates and analyze the potential savings this strategy will generate. CDPHP, HealthNow, MVP (leveraging the NYQA database), along with Health Plus, Healthfirst have agreed to share their data to examine the potential for a pilot implementation. Downstate, Montefiore Medical Center and HealthFirst and Healthlus have also agreed to share their data for analysis. An evaluation of this pilot phase will provide State policymakers with information on where wasteful spending can be eliminated from the health care system and whether this payment strategy will motivate providers to offer high-quality care at a lower cost.
Beginning in the summer of 2009, the Colorado Health Foundation (TCHF) and HCI3 began discussions around funding a new payment reform initiative for the state of Colorado. TCHF is a non-profit organization working to make Colorado the healthiest state in the nation, invests in the community through grants and initiatives to health-related non-profits. Colorado Business Group on Health is a non-profit coalition representing large purchasers of health care services, who’s mission is to advance the purchaser role to accelerate cost-effective, high quality health care. They will act as a facilitator for the initiative.
Because of the ambitious nature of the original proposal, it was decided that the funding should be broken into two grants: 1) a data gathering and analysis phase with the objective of designing two or more Prometheus pilots involving multiple stakeholders, and 2) assuming success in the study grant, a three-year implementation grant to put the Prometheus design deliverables of the study grant into motion. The grant objectives are threefold: 1) Determine the feasibility of payment reform in various Colorado communities by convening stakeholder groups that will analyze payer data and design unique implementation plans. 2) Stimulate the creation of patient-centered accountable, leading to higher quality care while controlling the increase in total cost of care. 3) Obtain buy-in from physicians, hospitals, employers and health plans as a key step to ensure a successful implementation. The study grant mainly revolves around an in-depth ECR PAC analysis, and sharing of the PAC results; if TCHF goes ahead with the Implementation grant, HCI3 will work with a Steering Committee to put Prometheus Payment into motion at three pilot sites.
With costs rising at unsustainable rates, it's time to put payment reform into practice – and your organization can play a central role. Let us design a PROMETHEUS pilot for you. Contact us at [email protected]