Colorado Business Group On Health

Your Partners In Quality

Healthcare Incentives Payment Pilot (HIPP)

The Healthcare Incentives Payment Pilot(HIPP) is a statewide initiative based on the PROMETHEUS Payment® program, which was created by the Health Care Improvement Initiatives, Inc. (HCI3).  PROMETHEUS uses data from insurance claims to measure costs associated with potentially avoidable complications (PACs) in patients with chronic diseases. Studies on PAC rates in the U.S. show that about 30% of the cost of care for chronically ill patients are due to PAC waste in the system.  The PROMETHEUS engine works by isolating these PACs from typical costs, which are expected costs when a patient is properly managed. For example, routine physician services and preventative medicine are part of the typical costs to care for an asthmatic patient.  On the other hand, if this patient visits an emergency room for severe bronchial restriction, the PROMETHEUS engine would flag this as PAC.

In the current fee-for-service system, healthcare providers are encouraged to see more patients and not incentivized to spend time managing a single patient.  By sharing clinically-based actionable reports from the data to the healthcare provider through the PROMETHEUS program, there is great potential for PACs to be reduced resulting in the opportunity of cost savings for the providers.

Colorado is the first state to use PROMETHEUS on a community-wide basis to help reduce healthcare costs.  The Colorado Health Foundation has funded $3M for a 3-year project in three Colorado communities: Boulder/Longmont, the San Luis Valley, and Colorado Springs.  This project is in its third year and has shown feasibility and buy-in in the three target communities.  Many self-funded employers are participating in the Colorado PROMETHEUS pilot, with the support of the Colorado Business Group on Health.

If you have any questions or would like to discuss PROMETHEUS, please contact Bob Smith at Robert.Smith@CBGHealth.org

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