The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems In Implementing New Payment Models
Abstract
Fee-for-service payment is blamed for many of the problems observed in the US health care system. One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects. The project has faced substantial implementation challenges, and none of the three pilot sites had executed contracts or made bundled payments as of May 2011. The pilots have taken longer to set up than expected, primarily because of the complexity of the payment model and the fact that it builds on the existing fee-for-service payment system and other complexities of health care. Participants continue to see promise and value in the bundled payment model, but the pilot results suggest that the desired benefits of this and other payment reforms may take time and considerable effort to materialize.
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Complex financing strategies may require their own implementation support, as considerable challenges to execution have been observed.
“complex strategies may require their own implementation support, as considerable challenges to execution have been observed [69, 70].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [70]
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Kirby, J. S., Silva, C. F., Ferguson, S. B., Shupp, D. L., Marks, J. G., & Miller, J. J. (2019) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2018.09.012 · Cited by 1 · see citing works
Evaluability Assessment and Evaluation Options for an Elder Abuse Shelter Model
Smucker, S., Taylor, J., Todd, I., Hoch, E., Martineau, M., Clark, D., Cahill, M., & Friedman, E. M. (2023) · RAND Corporation eBooks · doi:10.7249/rra931-2 · Cited by 1 · see citing works
- Authors
- Hussey, P. S., Ridgely, M. S., & Rosenthal, M. B.
- Affiliations
- RAND Corporation (US)
- Harvard University (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2011-11
- Volume
- 30
- Issue
- 11
- Pages
- 2116-2124
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W2107205633
- Cited by
- 127
- References
- 10
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 3 · 2020: 8 · 2019: 8 · 2018: 5 · 2017: 9 · 2016: 17 · 2015: 25 · 2014: 12 · 2013: 14 · 2012: 5
- FWCI
- 25.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- bundled payment, fee-for-service, Affordable Care Act, health care payment reform, pilot project
- MeSH terms
- Diffusion of Innovation, Pilot Projects, Reimbursement Mechanisms, United States, Episode of Care, Models, Organizational
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