Address correspondence to Francois de Brantes, M.S., M.B.A., Executive Director, Health Care Incentives Improvement Institute Inc., 13 Sugar Street, Newtown, CT 06470; e-mail: firstname.lastname@example.org. Amita Rastogi, M.D., M.H.A., Chief Medical Office, is with the Health Care Incentives Improvement Institute Inc., Munster, IN. Michael Painter, J.D., M.D., Program Officer, is with the Robert Wood Johnson Foundation, Princeton, NJ.
Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach
Article first published online: 8 NOV 2010
© Health Research and Educational Trust
Health Services Research
Volume 45, Issue 6p2, pages 1854–1871, December 2010
How to Cite
De Brantes, F., Rastogi, A. and Painter, M. (2010), Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach. Health Services Research, 45: 1854–1871. doi: 10.1111/j.1475-6773.2010.01136.x
- Issue published online: 8 NOV 2010
- Article first published online: 8 NOV 2010
- Payment reform;
- quality of care;
- efficiency of care
Objective (or Study Question). To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness.
Data Sources/Study Setting. A claims database of 3.5 million commercially insured members under age 65.
Study Design. We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model.
Principal Findings. We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs.
Conclusions. By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent.