Word: model
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Dates: during 2000-2009
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MEDICARE-BASED Providers would be paid the same rates as from Medicare. Premiums would be the lowest of any model, but government costs would be the highest...
SELF-SUSTAINING Premiums collected would cover the cost of claims. Patients would pay more than under the Medicare model but less than for private insurance...
This is the guiding principle of a pilot payment model called Prometheus, which, by January 2010, will be used to calculate insurance coverage for 80,000 workers in Rockford, Ill., and has already caught the eye of the White House. Why? Because it turns the current insurance reimbursement system on its ear. See the top 10 medical breakthroughs...
...major problem with American health care today is what policy experts call "perverse incentives." Doctors and hospitals bill insurers for every individual service - every office visit, MRI or hour of operating-room time - a "fee for service" model that drives health-care inflation by rewarding providers who order potentially unnecessary tests, perform potentially unnecessary surgeries and even make mistakes. A hospital readmission caused by avoidable complications just means more billable expenses...
...contrast, Prometheus, funded by a $6 million grant from the Robert Wood Johnson Foundation, calculates compensation for hospitals and doctors based not on the specific treatments a patient receives but on the care a patient should receive "per episode." (Prometheus's calculation model is an open-source program that is already garnering interest from insurers in Minnesota, Pennsylvania and elsewhere...