Building Support: CEO Leadership and Champions

Senior-Level Support is Essential

Once you decide to implement PROMETHEUS Payment, a key step is to obtain formal commitment from the CEOs of all participating payer and provider organizations. CEO support can be expressed through letters of commitment.

This is critical because a high-stakes payment initiative like PROMETHEUS will impact many areas of the organization. During the pilot, many diverse professionals—from the nurses and physicians who redesign care delivery to the finance and informatics people who update payment and accounting systems—will need to collaborate closely. They must know their efforts have the CEO’s full support, attention and enthusiasm.

While backing from another C-suite executive (such as the person in charge of fund allocation or discretionary spending) can have a powerful impact, it can’t compare to CEO-level support. The CEO is the ultimate decision-maker and is accountable for the organization’s success or failure. With final say over allocation of resources, only the CEO can send a message all the way down the reporting lines about corporate priorities.

As a result, the CEO’s full, public commitment through something like a letter is essential. If the signal from the top isn’t clear, mid-level managers will inevitably struggle with finding and maintaining the resources needed to implement such a complex project. At some point, a corporate priority that is clearly backed by the CEO will override all other considerations, and resources will be allocated accordingly. Having the CEO drive engagement tells everyone that this effort will be supported.

What a CEO Commitment Letter Should Indicate

A CEO commitment letter should indicate that PROMETHEUS implementation is a priority for the organization, that it fits well within his/her vision and that it is urgently needed to improve quality and cost efficiency. The letter must also state that your organization has the resources in place to execute the implementation, or is willing to allocate resources as needed (for example, billing systems and contracts may have to change for the pilot to take place). The letter should spell out these requirements and explain that PROMETHEUS will be a priority for every member of the organization.

A Physician Champion is Important, Too

If possible, you should also have a physician champion on board to spread the message and build support. After all, this initiative represents a major shift in how physicians will be compensated and their skepticism and pushback are certainly to be expected. Having a physician who understands the program and is committed to its success will go a long way toward persuading other providers that PROMETHEUS will continue to compensate them at the current contracted amounts, while offering significant potential upside as well. The physician champion should focus on communicating the incentives for delivering better outcomes and explaining how PROMETHEUS rewards excellence by allowing top performers to earn more.

Caution Point

HCI3 has found that pilot organizations without engaged CEOs can take 2-3 times longer to accomplish the same milestones as other pilot sites. As a result, any organization involved in PROMETHEUS must have CEO commitment before any implementation is launched, ECRs are chosen, or contracts signed. Getting the various organizations—or departments within those organizations—to work together smoothly may be difficult if the CEOs do not state clearly that the pilot is a major organizational priority.