Health Care Financing Model Rewards Efficient Care

Incentives for reducing potentially avoidable costs put focus on quality

FRIDAY, Aug. 21 (HealthDay News) -- A health care financing model that includes incentives for reducing potentially avoidable costs can act as a bridge between the current fragmented system and one based on high-value care, according to an article published online Aug. 19 in the New England Journal of Medicine.

Francois de Brantes, of Bridges to Excellence in Newtown, Conn., and colleagues describe the Prometheus Payment model, which is based on the principle of bundled payment for a specific patient episode, but incorporates an allowance for complications that are potentially avoidable.

The researchers note that the bundled nature of payments would encourage disparate service providers to collaborate, and rewarding them for avoiding complications would incur considerable savings, given that potentially avoidable complications account for 22 percent of health expenditures in the private sector, and up to 80 percent of all expenditure in some instances.

"Prometheus is not appropriate for reimbursements for all conditions, but there is sufficient evidence to define both typical care and potentially avoidable costs for types of episodes that account for half to two-thirds of health care expenditure," the authors write. "At a minimum, our efforts to translate our conceptual model into practice suggest that it can effectively provide a bridge from the current fragmented delivery system to an accountable care system in which collaboration and the pursuit of excellence are the norm."

Several authors reported affiliations with the Prometheus Payment model.

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