PROMETHEUS Bundled Pay

Get all you need to create an easy-to-use, scalable bundled payment program

This is the only analytics platform designed to support bundled payment with an eye toward re-engineering care and rewarding providers for reducing potentially avoidable complications (PACs). It uses health care claims data to analyze episodes of medical care, create budgets, and easily track actual costs. It delivers a wing-to-wing process for implementing focused bundled payment programs, and provides the analytics infrastructure you need to revamp reimbursement and care system design.

Product Features

  • Provides today’s most robust analytics infrastructure to help you manage the financial risk of bundled payment programs
  • Lets you create prospective and severity-adjusted budgets from historical data – and easily track actual costs against those budgets
  • Promotes data transparency by creating comprehensive reports for payers and providers to monitor cost and quality improvements
  • Provides detailed per-patient reports that drill down to the claim line level to show where all costs were incurred
  • Tracks PACs, their potential causes, and associated costs to help focus your health care improvement efforts
Guy on a computer reviewing data

Health Systems

Get detailed per-patient reports, drilling down to the claim line level to know where all costs were incurred. Track avoidable complications and their potential causes.

Medicaid

Create prospective, severity-adjusted budgets based on historical data analysis. Get ongoing analysis comparing budgets to actual costs.

Health Plans

Create prospective, severity-adjusted budgets based on historical data analysis. Get ongoing analysis comparing budgets to actual costs.

Employers

Create prospective, severity-adjusted budgets based on historical data analysis. Get ongoing analysis comparing budgets to actual costs.

Horizon Healthcare Services of New Jersey used PROMETHEUS Analytics to implement bundled payments for nine conditions and procedures. More than 12,000 care episodes were completed under the program.  Key benefits included quicker average recovery times after orthopedic surgeries, lower rates of unnecessary C-sections, lower costs for hip replacements, and fewer readmissions after knee arthroscopy. Costs were contained well enough for Horizon to pay out $3 million in shared savings to 51 participating specialty medical practices.

Community Health Choice (CMC), a nonprofit Medicaid HMO, joined a maternity care bundled payment pilot to encourage better prenatal care, discourage C-sections, and reduce the number of premature and low birth weight babies. PROMETHEUS Analytics were integral to the program’s design, implementation and measurement. The systematic collection of quality data showed the importance of treating prenatal care, labor/birth, and postpartum care as connected phases of one episode, rather than three separate episodes. This continuum of care, coupled with bundled payment, addresses important structural issues that can lead to improved outcomes.

To test value-based payment programs, the Pennsylvania Employees Benefit Trust Fund (PEBTF) piloted a bundled payment model for total knee and hip replacements. PROMETHEUS Analytics were used to guide program design, create episode of care budgets, and evaluate quality data. The pilot yielded a wealth of knowledge around budgeting, risk management, care processes, and provider integration. For example, the data showed that including rehabilitation care in the payment model improved outcomes and value significantly. Overall, patient evaluations of their care were positive, and costs outside of inpatient stays declined an average of $4,189.  

Client Testimonials

Case Studies