Francois de Brantes

A Systemic Approach to Containing Health Care Spending

Two Sounding Board articles, by Emanuel et al. and Antos et al., discuss different approaches to controlling rising health care costs in the United States. The editors hope that the range of options presented will stimulate discussion and debate on the best ways to bend the health care cost curve.

Building a Bridge from Fragmentation to Accountability — The Prometheus Payment Model

What kind of payment system could promote and sustain high-value care and motivate the development of accountable care organizations? Francois de Brantes, Meredith Rosenthal, and Dr. Michael Painter describe the Prometheus Payment model.

Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach

UNLABELLED 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. DATA SOURCES/STUDY SETTING A claims database of 3.5 million commercially insured members under age 65. STUDY DESIGN We analyzed the database using the Prometheus Payment models 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. PRINCIPAL FINDINGS 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.

Bridges to Excellence--recognizing high-quality care: analysis of physician quality and resource use.

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.