Spectrum Health Participates in National Pilot for Payment Reform

One of only four Robert Wood Johnson-funded pilot sites in the country

Spectrum Health announced today that it is one of four pilot sites selected to participate in a groundbreaking payment reform experiment funded by the Robert Wood Johnson Foundation. The PROMETHEUS Payment® model focuses on transitioning from payment for each care encounter to a single payment for an entire episode of care, often referred to as a bundled payment. The payment model is based on delivering value-driven health care that offers strong incentives for clinical collaborations and efficiency.

Spectrum Health has been chosen as one of the pilot sites for the three-year project with participation from each of its business units-the Spectrum Health Hospital Group; physicians from the Spectrum Health Medical Group, mmpc and West Michigan Heart; and its health plan, Priority Health.

“Our involvement in the PROMETHEUS project represents our ongoing exploration of new and better ways of delivering exceptional care and exceptional value, while providing options for patients,” said Richard C. Breon, president & CEO, Spectrum Health. “We are constantly looking for ways to drive change that will result in better access to care for our patients across our system, improved health outcomes and reduced costs. This pilot project is an opportunity to examine a payment reform approach that will benefit patients and anyone who pays for health care services. Ultimately it means delivering the right care at the right time and in the right place for the best possible outcomes.”

In the pilot program, Spectrum Health will apply the new payment methodology to treatment of congestive heart failure, diabetes, colon surgery, asthma and chronic obstructive pulmonary disease (COPD). As part of the pilot, Spectrum Health is working with its physicians to get input and agreement on commonly accepted clinical guidelines for the best treatment of the conditions from beginning to end.

The goal is that by bundling the payment, care will be more coordinated among physicians, hospitals and other providers. Spectrum Health will be working with physicians to redesign the system of care for greater efficiency.

“Spectrum Health was chosen as a pilot site because it is an integrated health care system, and the combination of a health plan and provider organization can offer some significant insights on how to improve performance when you have different financial mechanisms and data to manage the variation in costs,” said Francois de Brantes, CEO of Bridges to Excellence, which runs the PROMETHEUS Payment model. “The PROMETHEUS approach requires thinking of the whole-all aspects of the care experience-rather than the piece parts such as multiple physician encounters, diagnostic testing, physical therapy and hospital services for example. It requires a shift in thinking in the way care is delivered, measured and paid for in this country.”

Other pilots are being conducted in Minnesota’s twin cities, Rockford, Ill, and Chester, Penn. “The physicians, medical groups and hospitals participating in these sites have different characteristics and taken together they should provide some good insights to the potential for an episode of care payment model such as PROMETHEUS to improve quality and lower total cost of care,” de Brantes said.

Spectrum Health views this pilot project as a learning opportunity rather than a panacea.

“This is an opportunity to learn about options to reform our payment system and share that learning with others so that we can move closer to a solution for our entire industry,” Breon said. “We don’t expect this to be the definitive answer but we believe it is essential to evaluate and explore ways to change what is currently a highly complex financial interaction between patients, insurance payers, physicians and hospitals.”

PROMETHEUS (an acronym for Provider payment Reform for Outcomes Margins Evidence Transparency Hassle-reduction Excellence Understandability and Sustainability) is an outgrowth of Bridges to Excellence. Providing both administrative and programmatic support, BTE supervises the continued development of Evidence-Informed Case Rates® supported by MassPRO, the Massachusetts Quality Improvement Organization. In addition, BTE manages the implementation of the Prometheus Payment® Engine in collaboration with IRP-Claimshop® and is involved in the coordination and facilitation of overall implementation of the program at the pilot sites.

Spectrum Health is a not-for-profit health system in West Michigan that offers a full continuum of care through the Spectrum Health Hospital Group, a collection of seven hospitals and more than 140 service sites; the Spectrum Health Medical Group, mmpc® and West Michigan Heart-physician groups totaling more than 400 providers; and Priority Health, a health plan with 580,000 members. Spectrum Health’s 16,000 employees, 1,500 medical staff members and 2,200 volunteers are committed to delivering the highest quality care. The organization provided $79.4 million in community benefit during its 2009 fiscal year. As a system, Spectrum Health has earned more than 100 awards since it was formed in 1997.