HCI3 Library

Search results for: Issue Briefs

Identifying Sources of Variation in Asthma Episodes of Care with PROMETHEUS Analytics©

Issue Brief: Asthma

Focusing on improving care holds the potential to save money for payers and ultimately improve patient outcomes.A critical step toward those dual goals is to identify variation in the cost and quality of asthma care, and isolate opportunities for improvement.…

October 11, 2016

Best Practices to Maximize Consumer Use of Transparency Tools

Issue Brief: Health Care Price Transparency Tools

The benefits of transparency are only realized if consumers attend to and use the information in making choices. We know from years of experience and decades of research with health care quality transparency efforts, that the way in which information…

August 11, 2016

When is the Most Popular Procedure the One with the Worst Outcomes?

Issue Brief: Hysterectomies

There is a popular myth that laparoscopic surgery is always safer than regular surgery because it reduces the potential for wound infections and complications associated with longer lengths of stays. In many instances, that myth is validated. However, for this…

July 11, 2016

Identifying Sources of Variation in Diabetes Episodes of Care with PROMETHEUS Analytics

Issue Brief: Diabetes Care across the Country

Uncovering any inefficient spending or low-quality care associated with as prevalent and costly disease as diabetes holds the potential to save money for payers and improve outcomes for patients. A critical step toward those twin goals is to identify variation…

March 25, 2016

Developing a State-based Quality Measurement Program Using an Episode-of-Care Framework: Recommendations for State Purchasers

Introduction As the US health care system moves towards value-based payment, it becomes clearer that, while alternative payment models are important, the underlying information processes required to vivify these new payment models are equally critical to the success of the…

December 1, 2015

Piercing The Darkness: A Generalizable Approach To Reliably Measuring Quality Of Care

To help all states significantly improve their grades and provide important quality information on physicians, we have developed a rigorous methodology to calculate outcomes of patient care. The methodology is detailed in this companion White Paper to the Report Card.…

November 17, 2015

Reconciling ASO Bundled Payment Contracts in a Multi-Employer Setting

Bundled Payment: Why Employers Should Care Since the passage of the Employee Retirement Income Security Act (ERISA) in 1974, many employers, especially larger ones, have turned from the costlier practice of purchasing health benefits from health plans in state-regulated marketplaces.…

October 30, 2015

Health Information Technology in the United States, 2015

Why Payment Reform and HIT Interoperability Must Follow the Same Innovation Route

In the January 2007 issue of the Journal of Healthcare Information Management, we argued that the American health care system is “a dark, lumpy archipelago composed of tens of thousands of isolated corporate islands that, at least in terms of …

September 17, 2015

Getting Accurate Price Estimates from Price Transparency Tools

For millions of Americans, health care is increasingly becoming a retail market. More than one in five Americans with private insurance is enrolled in a high deductible health plan. According to the 2014 Kaiser Family Foundation survey of health care…

February 5, 2015

Key Payer and Provider Operational Steps for Successfully Implementing Bundled Payment

This is the third in a series of annual issue briefs that have tracked the development and implementation of bundled payments in the public and private sectors.  This brief builds upon the two previous issue briefs  by providing a more…

May 28, 2014

State Report Card on Transparency of Physician Quality Information

HCI3 Improving Incentives Report - December 2013

Introduction In its seminal publications on the Quality of Health Care in America, the Institute of Medicine called for the measurement and reporting of physician quality. That was in 1999 and 2000. Since then much work has been done in…

December 6, 2013

Reference Pricing and Bundled Payments

A Match to Change Markets

As the costs of health care continue to increase, employers are turning to innovations in health care payment, benefit design, and network design to manage their costs. One reform that has gotten recent attention is reference pricing. Yet when used…

November 14, 2013

Legal Issues in Designing Bundled Payments and Shared Savings Arrangements in the Commercial Payor Context

A promising method for restructuring the health care payment system involves packaging payments for multiple, related services into a “bundle” to pay for a single episode of care. For example, a bundled payment for a hip replacement surgery would include…

September 10, 2013

Improving Incentives to Free Motivation

“Improving Incentives to Free Motivation,” calls for an approach to payment reform that harnesses the inherent motivation that doctors and patients have to make good decisions about health care. The authors reject the assumption that health care costs will drop…

August 7, 2013

Bundled Payments One Year Later

An Update on the Status of Implementations and Operational Findings—May 30, 2013

Foreword Form drives function and incentives drive function. That's the basic principle that is driving so many to focus on moving away from fee for service to alternative payment models. In March, Catalyst for Payment Reform issued a scorecard showing…

June 10, 2013

HCI3 Improving Incentives Issue Brief: Tracking Transformation in US Health Care

How Do You Know You're Making Progress?

How do you know you’re making progress? That’s the question that everyone in health care should be asking, and be able to answer. In this Issue Brief we propose a few metrics that, collectively, should give us and others a…

January 17, 2013

HCI3 Improving Incentives Issue Brief: Designing the BPCI for Success

CMMI Bundled Payments for Care Improvement Requires Design Changes to Ensure Pilot Success

Objective: Examine the variation in costs within certain episodes of care to better quantify the risks and benefits to providers participating in the CMMI Bundled Payments for Care Improvement (BPCI). Methods: We performed a retrospective analysis of claims data using…

August 29, 2012

Igniting Health Care Payment Reform

A review of the PROMETHEUS Payment® approach describes the key components of a strategy to manage the rise in health care costs. Using common incentives and connecting payment to clinical practice guidelines and evidence-informed case rates can result in high…

June 20, 2012

What are Prometheus Payment Evidence-Informed Case Rates (ECRs)?

Predetermined budgets that are bundled to cover comprehensive, evidence-based, personalized care in treating a given condition.

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…

June 20, 2012

HCI3 Improving Incentives Issue Brief: Bundled Payment Across the U.S. Today

Status of Implementations and Operational Findings

Health policy discussion across the United States during the past few years has placed significant attention on the adverse effects of fee-for-service payment, the predominant method of paying for health care services in the country. Feefor- service payment has been widely criticized for financially motivating providers…

May 25, 2012

HCI3 Improving Incentives Issue Brief: Cutting Inpatient Days and ER Visits

Study Finds Improved Focus on Population Management and Chronic Illness Cuts Inpatient Days and Emergency Room Visits

Objective: To study the cost and utilization performance of primary care physicians (PCPs) with and without a patient-centered medical home (PCMH) designation or a Bridges to Excellence (BTE) Diabetes Recognition. Methods: We performed a retrospective analysis of claims data using…

May 2, 2012

Key Design Elements of Shared-Savings Payment Arrangements

August 2011 Issue Brief

Shared savings is a payment strategy that offers incentives for providers to reduce health care spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts. The concept has attracted…

April 19, 2012

PROMETHEUS: New Payment System, New Keys to Success

Criticism of the predominant payment systems in the United States is rampant. From the Institute of Medicine's call for payment reform in order to improve quality, to physician dissatisfaction with administrative burdens, to employer concerns about escalating costs, no one…

April 10, 2012

In Common Cause for Quality, Part 1

New Hospital-Physician Collaborations

The call for improved quality dominates the health care landscape. The Institute of Medicine’s Crossing the Quality Chasm, a dramatic increase in transparency, the advent of pay for performance and the 100,000 Lives Campaign are pressing all types of health…

April 10, 2012

In Common Cause for Quality Part 2

PROMETHEUS Payment® and Principles of Engagement

Quality demands alone ought to motivate hospitals to seek ways to collaborate more effectively with physicians. But the most significant lever to better hospital-physician relationships might be a different payment system. Pay for performance, while a positive development, is generally…

April 10, 2012