Prometheus Payment

Welcome! This toolkit is designed to provide the information you need to gain a solid understanding of the PROMETHEUS Payment ® model, consider the potential benefits of a pilot implementation and take action. It is meant for use by local health care cooperatives, employers, physicians or health plans interested in exploring the PROMETHEUS model.

In clear language, this toolkit explains the thinking behind this new payment approach and lays out the steps to implementation. It describes how to conduct your initial data analysis, build support among CEO leadership and other champions, engage your providers and payers, define your project scope and ultimately launch your pilot. It will also point you to additional resources to help you at each step.

The PROMETHEUS model was created by the Health Care Incentives Improvement Institute (HCI3), a non-profit organization guided by a Board of Directors that includes physicians, employers, health plans and others. Development has been supported primarily by grants from the Robert Wood Johnson Foundation (RWJF).

Is your region a good candidate for PROMETHEUS Payment implementation?
A PROMETHEUS pilot can be a complex undertaking. Here are some questions to consider before venturing down this path. You don’t need to answer “yes” to all of them now; the details will all be explained later in this toolkit. But these questions will help you begin to understand some key factors before you decide to move forward.

  • Is at least one payer and one provider organization willing (and eager) to participate?
  • Is payment reform a priority for each participating organization?
  • Can you count on the CEOs to be committed to this effort?
  • Are you willing to devote substantial time, and financial and human resources, to the pilot?
  • Does your staff include a skilled SAS programmer, strong analytics team and capable project manager? If not, can you get them on board?
  • Do providers have an Electronic Medical Records (EMR) system in place? If not, can they implement one?
  • Do payers have access to high quality claims data?
  • Will there be a sample of at least 30 patients – and preferably many more – in the areas you intend to focus your pilot on?
  • Is there a strong sense of urgency to overcome the obstacles that may arise?

Again, the details behind each question will be explained as you move through the toolkit. You don’t need to answer them now. But on a high level, you may already have a sense of whether your organization is a good candidate for a PROMETHEUS implementation.

One more thing to keep in mind: You can employ the PROMETHEUS model for purposes other than explicit payment reform.

Its data-driven approach has much to offer in helping your organization:

  • Understand the factors driving its costs;
  • Measure its quality of care against local and national benchmarks; and
  • Identify the most critical areas on which to focus its cost and quality improvement efforts.

Even just running your claims data through PROMETHEUS’ online tools can yield a wealth of information you can put to work in many different ways.

Bottom line: if you are considering a payment reform pilot, or simply want to identify areas that offer the best quality improvement and cost saving opportunities, this toolkit can be an invaluable resource.

Let’s get started!