Reducing potentially avoidable complications in patients with chronic diseases: the Prometheus Payment approach.
OBJECTIVE (OR STUDY QUESTION): To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness.


METHODS
A claims database of 3.5 million commercially insured members under age 65.


METHODS
We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model.


RESULTS
We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs.


CONCLUSIONS
By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent.
De Brantes
Francois
F
Health Care Incentives Improvement Institute Inc, 13 Sugar Street, Newtown, CT 06470, USA. francois.debrantes@hci3.org
Rastogi
Amita
A
Painter
Michael
M
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration*; D055815:Young Adult