Advancing Payment for Health Care Quality and Efficiency Through an Evidence-Based Case Rate Approach

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Prometheus is the name of a new model for paying health care providers based on evidence-based case rates (ECRs)--derived from the costs of resources required to deliver care according to clinical practice guidelines. With the addition of robust performance incentives, the model is designed to promote quality and efficiency. Clinical working groups have already been assembled to determine the "base rate" for prototype ECRs for cancer care, chronic care, interventional cardiology, orthopedic care, and routine and preventive care. This project will complete the development of at least five prototype ECRs, specifically by adjusting the base rates to account for unexpected events (e.g., hospitalizations), which can occur even when appropriate care has been provided, as well as for differences in severity of disease. If subsequent pilot-testing is successful, this payment model would advance the goal of aligning financial incentives with the delivery of high-quality, efficient care.

Grant Details

Grantee Organization:
Bridges to Excellence
Principal Investigator:
François de Brantes, M.B.A.
Award Amount:
$300,000.00
Approval Date:
November 14, 2006

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