Building a Bridge from Fragmentation to Accountability — The Prometheus Payment Model | Health Care Reform 2009

François de Brantes, M.S., M.B.A., Meredith B. Rosenthal, Ph.D., and Michael Painter, J.D., M.D. in the New England Journal of Medicine Our fee-for-service payment schemes have contributed to, if not largely created, the current fragmentation. Fee-for-service payments create incentives to provide high volume rather than high value — more, not better, care. So what kinds of payment could promote and sustain high-value care and motivate the development of accountable care organizations? Most experts agree that some sort of bundled, episode-based payment would help to move the system in the right direction. Our own approach, the Prometheus Payment model, for instance, bundles services and provides a budget with three components: evidence-informed base payment with patient-specific severity adjustments and an allowance for potentially avoidable complications (see box, “The Prometheus Model”).1,2 The model has been developed and evaluated through several small pilot projects, which offer some lessons about the ability of episode-based payment to improve cost and quality within the current fee-for-service system. This kind of payment aims to foster outcomes-focused collaboration among otherwise unaffiliated providers and offers a bridge from our fragmented system to a more integrated, accountable one. Read More