What are Prometheus Payment Evidence-Informed Case Rates?

From fee-for-service, to capitation, to episode-based models—proposals for paying providers in the United States’ health care system have come in all shapes and sizes over the decades. Tried and tested payment systems have all purported to be effective in addressing the fundamental problem in our nation’s health care reimbursement practice—that it encourages volume-driven health care, rather than value-driven health care. In other words, providers are rewarded for “doing things”—often too many and/or unnecessary things—rather than for delivering services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.

Yet despite decades of experimentation, as the U.S. health care system remains beset by widespread deficiencies and poor value, the current health reform debate reminds us how little progress has been made on this key issue. The payment reform models implemented so far have proven to be inadequate at sustaining a system that pays providers fairly, yet still improves quality and reduces costs.

The PROMETHEUS Payment® model seeks to do this, igniting a transformation in health care payment by moving away from unit-of-service payment to episode-of-care payment. This brief explains Evidence-informed Case Rates® (ECRs), the core element of the PROMETHEUS Payment model. Payment packages centered around a comprehensive episode of medical care, ECRs are bundled patient-specific budgets that cover all treatments related to a single illness or condition. They offer an effective solution to paying for individual, patient-centered treatment plans that fairly reward providers for coordinating and providing high-quality, efficient care.