|Spectrum Health Joins PROMETHESUS Pay Model Pilot
Spectrum Health of West Michigan joins the national
payment reform pilot, funded by the Robert Wood Johnson Foundation
(RWJF) with over $6.4 million in grants for the life of the project.
The pilot has been adopted by four healthcare regions to
test provider payment reform for outcomes margins evidence transparency
hassle-reduction excellence understandability and sustainability
(PROMETHEUS) payment model.
Realizing the healthcare need for a new payment model
that rewards quality care and not quantity and recognizing the need to
slowly implement a new payment model to avoid, as PROMETHEUS’
design team leader and national coordinator François de Brantes
described as, trying to turn around a Mack truck speeding down the
payment superhighway at about 80 miles per hour and gaining speed as it
goes, the evidence-based case rate model was created.
"If we pull the e-brake on that truck, you’re
going to have a big mess. We need to slow down the Mack truck in a
responsible fashion ... Changing the payment system is incredibly
complicated and takes time," he said.
This payment model will make a single payment for all
services rendered for an entire episode of care, establishing a bundled
payment system forcing coordination among multiple providers.
"Episode payments – where a gamut of services are
grouped together for a single reimbursement, instead of being paid
separately – could give hospitals, doctors and other providers an
incentive to provide more efficient care and reduce unnecessary
hospital readmissions, since they won’t get paid for doing more.
In this model, providers decide what services are provided within a
particular episode of care, but bear none of the financial
responsibility for probability risk," said RWJF.
Spectrum Health will be applying the payment model to
treatment of congestive heart failure, diabetes, colon surgery, asthma
and chronic obstructive pulmonary disease. The Spectrum Health Hospital
Group, Spectrum Health Medical Group, mmpc, West Michigan Heart and its
health plan, Priority Health, will be reimbursed through PROMETHEUS for
the next three years.
The doctors will collaborate to determine the
appropriate clinical guidelines to apply to the model that will
calculate the reimbursement for the total care.
"Our involvement in the PROMETHEUS project represents
our ongoing exploration of new and better ways of delivering
exceptional care and exceptional value, while providing options for
patients. We are constantly looking for ways to drive change that will
result in better access to care for our patients across our system,
improved health outcomes and reduced costs," said Richard Breon,
president and chief executive officer of Spectrum Health.
"This pilot project is an opportunity to examine a
payment reform approach that will benefit patients and anyone who pays
for healthcare services. Ultimately, it means delivering the right care
at the righttime and in the right place for the best possible
outcomes," he said.
"Spectrum Health was chosen as a pilot site because it
is an integrated healthcare system, and the combination of a health
plan and provider organization can offer some significant insights on
how to improve performance when you have different financial mechanisms
and data to manage the variation in costs," said de Brantes.
"The PROMETHEUS approach requires thinking of the whole
– all aspects of the care experience –rather than the piece
parts such as multiple physician encounters, diagnostic testing,
physical therapy and hospital services, for example. It requires a
shift in thinking in the way care is delivered, measured and paid for
in this country," he continued.
Minneapolis, Min., Rockford, Ill. and Chester, Pa. are the other areas PROMETHESUS will be used to pay for healthcare.
"The physicians, medical groups and hospitals
participating in these sites have different characteristics and taken
together they should provide some good insights to the potential for an
episode of care payment model such as PROMETHEUS to improve quality and
lower total cost of care," de Brantes said.
For more information on Spectrum Health, visit www.spectrum-health.org.
Address: Robert Wood Johnson Foundation, Route 1 and College Road East, P.O. Box 2316, Princeton, NJ 08543; (877) 843-7953, www.rwjf.org.