Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach
Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach
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DOI：
10.1111/j.1475-6773.2010.01136.x
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发表时间：
2010-12-01
影响因子：
3.4
通讯作者：
Painter, Michael
中科院分区：
文献类型：
--
作者：
de Brantes, Francois;Rastogi, Amita;Painter, Michael
目的（或研究问题）为了确定新的支付模式是否可以减少慢性病患者潜在可避免并发症（PAC）的发生率。数据来源/研究设置一个包含350万65岁以下商业保险成员的索赔数据库。研究设计我们使用Prometheus支付模式的分析软件分析了六种慢性病的数据库，以量化总成本、PAC支出比例、以及它们在美国各地的变化。我们进行了文献综述，以确定减少PAC的可行性。我们估计了一个典型的做法，如果该做法收到付款的基础上Prometheus Payment model.Principal FindingsWe发现，（1）PAC消耗的费用平均为28.6%的六个慢性疾病的研究和差异显着;（2）减少PAC的第二个十分位数的水平将节省美元1.167亿在这一人群中;（3）目前的文献表明，在某些情况下的做法可以减少PAC;和（4）使用普罗米修斯模型可以创建一个大的潜在激励的原型做法，以减少PACs.ConclusionsBy推断这些研究结果，我们得出结论，通过支付改革的努力，成本可能会降低。对这些结果的全面推断，虽然是推测性的，但表明与所研究的六种慢性疾病相关的总成本可能会降低3.8%。
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 SettingA claims database of 3.5 million commercially insured members under age 65.Study DesignWe 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.Principal FindingsWe 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.ConclusionsBy 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.