New Evidence Based Medicine Payment Model Proposed

A multi-disciplinary group organized as Prometheus Payment Reform, Inc. is proposing a new health care provider payment model using “Evidence-Based Case Rates” that seek to tie the payment to compliance with evidence based medical guidelines. “The initial focus of the model is on five specific clinical areas: cancer care (starting with lung and colon cancers), chronic care (starting with diabetes, depression, hypertension and hyperlipidemia), interventional cardiology, orthopedic care (in particular joint replacements) and routine and preventive care.” The group which includes executives from Bridges to Excellence, the Leapfrog Group, the Blue Cross and Blue Shield Association, and the American Hospital Association, currently is preparing to conduct pilot tests of the model in several regions.