States and Health Plans Deploying HCI³ Analytics for Transparency and Payment Reform Efforts

PROMETHEUS Analytics® selected to support statewide programs in Maryland and New York; certified partners launch solutions for payers

Feb 12, 2016, 13:08 ET from Health Care Incentives Improvement Institute

NEWTOWN, Conn., Feb. 12, 2016 /PRNewswire-USNewswire/ -- According to the non-profit Health Care Incentives Improvement Institute (HCI3), there's progress in building and deploying the tools that can improve the affordability and quality of health care in the US. New advancements are underway in Maryland and New York State.

"To succeed in alternative payment models, payers and providers need analytic and operational tools that can quickly pinpoint the greatest areas of opportunity to improve the affordability and quality of health care," said François de Brantes, HCI3 Executive Director. "The PROMETHEUS Analytics® deliver better, more sophisticated insights than any other health care analytic product on the market. In addition, our open source episode definitions, which are rapidly becoming the industry norm, create fully transparent, meaningful accountability for costs of care. That's what states are counting on when they choose to build their transparency and payment reform efforts on our work. And that's why our partners have developed powerful solutions that incorporate the PROMETHEUS Analytics."

Maryland analyzing health care prices
The Maryland Health Care Commission has deployed PROMETHEUS Analytics on its All Payer Claims Database (APCD), the Maryland Medical Care Data Base (MCDB), to facilitate the analysis of health care prices. The Commission will use HCI3's analytics to test and validate reports on the price of health care services in Maryland, and to promote price transparency. The MCDB holds enrollment, provider, and claims data generated by Maryland residents, whether they're enrolled in private insurance, Medicare, or Medicaid Managed Care Organizations. Supporting estimates of cost and utilization, policy analyses, and evaluations of demonstration programs, the MCDB is an essential tool for State partners—such as the Maryland Insurance Administration and the Health Services Cost Review Commission—to make informed decisions.

New York State changing health care payment
New York State's Delivery System Reform Incentive Payment (DSRIP) program is dedicated to restructuring the health care delivery system, including changing how physicians, hospitals and other providers are paid by Medicaid Managed Care Organizations. It's the main component of the state's implementation of the Medicaid Redesign Team Waiver Amendment.  

The PROMETHEUS Analytics have been selected as the preferred method to calculate maternity and chronic-care bundles for DSRIP as well as to analyze other costs of care and create actionable reports for health care providers. The Analytics are being deployed on the state's Medicaid Data Warehouse and will be fully integrated into the support structure for the DSRIP program and associated value based payment work.

Certified HCI3 Partners
Several companies have now successfully created analytic and operational solutions to support bundled payment programs and big data mining in health care. Artemis, Aver, FairHealth, HealthQx and TriZetto have developed powerful solutions, leveraging HCI3's PROMETHEUS Analytics to create unique insights on the cost and quality of health care, in turn supporting payers and providers in the implementation of bundled payment programs. At the National Payment Innovation Summit in Memphis, Tenn., de Brantes announced that these organizations are now Certified HCI3 Partners, adding to the growing the list of organizations serving the diverse needs of payers, providers and purchasers in a rapidly evolving health care payment environment.

About PROMETHEUS Analytics
PROMETHEUS Analytics were developed to analyze episodes of care from claims data to create an Evidence-informed Case Rate (ECR) budget that can be used for price and quality transparency, value-based payment models, and network performance evaluation in order to improve the quality of care and patient outcomes.

About HCI3
Health Care Incentives Improvement Institute, Inc. (HCI3®) is a not-for-profit organization that aims to create significant improvements in the quality and affordability of health care through evidence-based incentive programs and support of payment reform models. Its nationally recognized programs, Bridges to Excellence® and PROMETHEUS Payment® have been at the forefront of payment reform, and the new PROMETHEUS Analytics® offers transformational insights for payers and providers.

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SOURCE Health Care Incentives Improvement Institute