Episodes of Care Based Healthcare Reimbursement Explained

I've talked a lot about changing healthcare reimbursement from basic fee-for-service to reimbursing based on outcomes called "episodes of care". Here's a non-technical, consumer friendly overview of it from the Robert Wood Johnson Foundation.


Using Episode Payment to Fix Our Fragmented Health Care System


Can Episode-of-Care Based Payments Be the Bridge That Finally Brings Accountability to America's Fragmented Health Care System?
A critical part of restructuring the health care delivery system is the need to develop an effective payment formula that rewards professionals for delivering high-quality, coordinated and efficient care.

Many argue that the current fee-for-service and per-patient (capitation)-style payment models have led to a fragmented U.S. health care system beset by poor performance and dysfunction. Rather than encouraging value-driven health care, these reimbursement models reward volume-driven care—where providers are paid for “doing things” (often too many or not enough), rather than working together to deliver quality services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.

In a Perspectives article published online in the New England Journal of Medicine, authors François de Brantes, Meredith Rosenthal and Michael Painter discuss how episode-based payments—and specifically the RWJF-funded PROMETHEUS Payment® model—might be the bridge that brings integration and accountability to America’s fragmented health care system.

A revolutionary payment model currently being piloted in communities across the country, PROMETHEUS Payment offers a potential blueprint for a new health care payment system. It effectively promotes and rewards high-quality, efficient, patient-centered care; provides common performance incentives for all parties; and creates an environment where doing the right things for patients also allows providers and insurers to do well financially.

LINK to the extended article: http://www.rwjf.org/qualityequality/product.jsp?id=47429