Reducing potentially avoidable complications in patients with chronic diseases: the Prometheus Payment approach

Area of Science:

• Health economics
• Healthcare management
• Patient safety

Background:

• Potentially avoidable complications (PACs) represent a significant cost burden in chronic illness care.
• Current payment models may not adequately incentivize the reduction of PACs.

Purpose of the Study:

• To evaluate a new payment model's potential to reduce PACs in patients with chronic conditions.
• To quantify the financial impact of PACs and the potential savings from their reduction.

Main Methods:

• Analysis of a claims database of 3.5 million commercially insured members.
• Utilized Prometheus Payment model software to assess costs and PACs for six chronic conditions.
• Conducted a literature review on PAC reduction feasibility and estimated financial impact on a prototypical practice.

Main Results:

• PACs account for 28.6% of costs for studied chronic conditions, with significant variability.
• Reducing PACs to the second decile could save an estimated $116.7 million.
• The Prometheus model offers a strong incentive for practices to decrease PACs.

Conclusions:

• Payment reform, utilizing models like Prometheus, has the potential to reduce healthcare costs.
• Extrapolated findings suggest a potential 3.8% decrease in total costs for the studied chronic conditions.