Before Paul Brand finished explaining Prometheus Payment, employers, providers and insurers were nodding their heads, understanding its potential for reducing health care costs.
Brand is executive director of the Employers' Coalition on Health, based in Rockford, Ill. It is a pilot project site for the Prometheus Payment method of buying health care.
On Friday, he was in Wichita at the invitation of the Wichita Business Coalition on Health Care, ProviDRs Care Network and the Sedgwick County Health Care Round Table. The business coalition is looking for ways to improve quality while holding down health care costs.
Prometheus focuses on doing that, in part by linking payment to quality.
A manufacturer wouldn't be paid twice to fix something that wasn't done right the first time, Brand said.
But that tends to be how health care is paid for, he said, using treatment for an infection after surgery as one example.
Employers tend to get behind the Prometheus concept when Brand explains to them that for some health conditions, "potentially avoidable complications," or PACs, make up 50 percent or more of treatment costs.
Prometheus rewards for "doing all the right things right the first time," he said.
It analyzes claim data to determine the cost of nationally agreed upon standards of care, along with typical costs for PACs.
Reimbursements are based on those figures, with rates adjusted for each community.
Prometheus Payment isn't capitation — each "episode of care," whether a heart attack or a chronic condition is paid for separately, and each is based on an individual patient — Brand said: Care for a patient with diabetes who has a heart attack isn't paid at the same rate as for a different heart attack patient.
In Rockford, if the PAC cost for 2010 is at least 6 percent less than in 2009 and if total spending is equal to or less 2009's, providers will share with the coalition in the savings.
Brand said using Prometheus costs employers less than $2 per month per employee. Reducing potentially avoidable complications by even 5 percent would more than make up that cost, he said.
Even if it doesn't change the status quo, Brand said, using Prometheus will result in mountains of data that can be used to move the market and guide purchasing.
With the Wichita coalition's efforts, "The data is something we've all said we've got to have," said Karen Cox of ProviDRs Care.
Data allows benchmarks to be set, added Kathy Sexton, Derby city manager.
Brand's Employers' Coalition on Health is made up of 145 employers who buy their health care together. Nearly all are self-funded, and most have between 200 and 300 employees. The largest insurer in the area is Blue Cross and Blue Shield of Illinois.