Why is this important?
At its core, the U.S. health care system exists to serve and improve the health of its people. However, the current state of this system is that of a multi-faceted industry, riddled with inefficiency, asymmetry, and high costs. Among developed nations, the U.S. is one of the greatest spenders of care, yet the health of its people lags behind that of other countries who spend far less. Consumers have a hard time navigating the system and are often the primary sufferers of unaffordable, lackluster care.
Realizing the issues that we currently face, Health Care Incentives Improvement Institute (HCI3) has a vision for the U.S. health care system. Through our efforts, we hope that reform will bring about a better system in which:
- Clinicians know which treatment patterns provide the best outcomes, especially for the chronic conditions most harmful to our nation’s health and finances. The guidelines are easy to follow and based on years of empirical study.
- Hospitals manage and treat patients with greater effectiveness and far fewer mistakes. The rate of unnecessary readmissions is vastly reduced, and patients view hospitals as beacons of excellence.
- Clinicians and hospitals are rewarded for the quality of care they provide, not the number of tests or procedures they perform. They have incentives to collaborate closely, and information to improve patient health without over-treatment or under-treatment.
- Consumers are fully engaged in making high value choices and actively participating in rewarding physicians that deliver higher quality care.
- The massive inefficiencies in today’s system are eliminated. Money is redirected in ways that make proven medical and financial sense, and top performers earn the most. In this vision, our innovative and dynamic society finally has a health care system to match.
What are our strategies to addressing this work?
We began with a simple mission: to create significant leaps in the quality of the nation’s health care. Our goal from the start has been to recognize and reward clinicians who have implemented comprehensive solutions in the management of patients, and deliver safe, timely, effective, efficient, equitable, and patient-centered care. We have implemented our programs in communities across the country, working collaboratively with clinicians, hospitals, employers, health plans and others, through two brands:
- PROMETHEUS Payment®: A compensation approach based on medical episodes of care, that provides a fair and realistic blueprint for true payment reform, and powered by the PROMETHEUS Analytics®.
- Bridges to Excellence® (BTE): A family of programs to reward Recognized physicians, nurse practitioners and physician assistants who meet certain performance measures.
What is PROMETHEUS Payment?
PROMETHEUS Payment is an alternative payment model that has become the basis for most national bundled payment programs.
Compensates providers fairly—and rewards excellence by allowing top performers to earn more. 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 full range of issues that can drive profound, long-term, system-wide improvements. This model:
- Offers direct and powerful incentives for providers to deliver greater value and better outcomes.
- Encourages caregivers to work in teams, share information, and take collective responsibility for a patient’s health.
- Provides a realistic framework to transform today’s fragmented and inefficient system into one that is far more integrated and accountable.
By bringing economic incentives in line with the medical profession’s strong desire to improve patient health, PROMETHEUS creates an environment where doing the right things for patients helps providers and insurers do well financially. And it does this without introducing new administrative burdens, or changing the way patients access care.
What is Bridges to Excellence?
Bridges to Excellence programs recognize and reward clinicians who deliver superior patient care.
Our programs measure the quality of care delivered in provider practices. We place a special emphasis on managing patients with chronic conditions, who are most at risk of incurring potentially avoidable complications. Our Recognitions cover all major chronic conditions, plus office systems – and a real Medical Home measurement methodology to promote comprehensive care delivery and strong relationships between patients and their care teams.
Physicians, nurse practitioners, and physician assistants who meet our performance benchmarks can earn a range of incentives that can include:
- National recognition for excellence in care through our partner websites, such as CastLight, Vitals, and the Blue Card Directory.
- Recognition by health plans in their on-line directories, such as Aetna.
- Pay-for-performance payments in some of our implementation sites, such as Texas and Colorado.
For well over a decade, Bridges to Excellence has helped thousands of clinicians receive the recognition they deserve for delivering high quality care to their patients, and most clinicians can apply for recognition free of charge through their electronic medical care vendors.
What are the PROMETHEUS Analytics©?
The PROMETHEUS Analytics© were developed to do exactly what the name suggests: analyze episodes of care from claims data to create an evidence-informed case rates (ECR) budget that can be used for value-based payment models and performance evaluation, in order to improve the quality of care and patient outcomes. The system contains all the core components and logic to fully evaluate and support payment reform models by determining:
- what kinds of reform will be most effective and where the reform should be focused.
- the potential for savings or improvement of care.
- who are the most efficient and highest quality providers.
PROMETHEUS Analytics© is constructed of key features that no other analytical system currently offers:
1) PROMETHEUS Analytics© separates costs of “typical” care from costs associated with potentially avoidable complications, or PACs. PACs, at the core, are events that negatively impact patients and are controllable by providers. Prospective ECR budgets created by the PROMETHEUS Analytics© include an allowance for PACs, which can act as an incentive to improve quality and reduce unwarranted costs.
The separation of PAC versus Typical costs also allows for performance comparisons of providers, as a high PAC rate can be an indicator of low quality, whereas a low PAC rate can be associated to high quality care. For example, the following graph shows specific providers, represented by bubbles, and their average costs of PACs and Typical care for a specific episode. Providers in the lower left quadrant are both more efficient and provide higher quality care.
Complications can be a significant source of variation in cost, so by identifying them, it enables the creation of a plan to decrease overall costs while improving the quality of care.
2) PROMETHEUS Analytics© is comprised of an overarching clinical logic in which episodes are associated with one another. This allows inferences about costs of care at many different levels, and contracting at different levels of accountability. See the Core Components of PROMETHEUS Analytics© for more information.
3) While most analytical systems typically have static rules, the PROMETHEUS Analytics© allows for flexibility and parameter changes within episodes. This permits accurate customization within the specific dataset to fit user needs, based on what the analysis is being used for (i.e., bundled payments, cost, or quality analysis).