Managed Care Information Center
MCIC Home
E-Mail MCIC
Site Navigation:
E-mail a Friend
FREE E-Mail Newsletters
Subscribe to the leading management newsletters
Search
Search
Affiliates
Health Resources Online
* * *
Health Resources Publishing
* * *
Wellness Junction
* * *
Healthcare Intelligence Network
Contact MCIC
info@themcic.com

Managed Care Information Center
1913 Atlantic Ave., Suite 200
Manasquan, NJ  08736
(732) 292-1100
fax: (732) 292-1111

Home / News & IndustryManaged Care Insight and Analysis
Updated: May 18, 2010
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.


  This article was taken from:
Healthcare Reimbursement Monitor

Free Trial Subscription

Become a Subscriber

    Back to This Week's List of Articles

"Managed Care Weekly Watch"
Subscribe Here

Email:

Name:

 
Top | Home


Resource of the Month | Database of MCOs | Publications | News & Industry | Surveys & Research | Free Products | Advertising Arena | Inside MCIC | Managed Care Archives | ManagedCareMarketplace.com | For Subscribers | Customer Service

©2010 The Managed Care Information Center