A SWOT Analysis of Evidence-Based Case Rates (ECRs): A promising new U.S. payment model for improving health care cost effectiveness and quality

Objectives: We researched Evidence-based Case Rates (ECRs) as a new payment model, and its integration into the nation's largest provider of healthcare, the Centers for Medicare and Medicaid Services (CMS), to show feasibility at the national level in light of the passage of the Healthcare Reform Bill. Methods: Using a SWOT analysis, a strategic planning tool, we evaluated several literature reviews of current payment models and case studies on Fee-for-service (FFS), capitation, and ECRs. Additionally a personal interview with PROMETHEUS' developer Francois de Brantes, CEO of Bridges to Excellence, was also conducted. Results: Preliminary results of PROMETHEUS' pilot programs have been successful. Its ability to operate alongside current payment schemes encourages care coordination, which helps subsitute and might reduce costs about 5.45% between 2010 to 2019. Conclusion: ECRs are a strong candidate in the next of wave of healthcare payment models as estimations assume that providers can achieve a reduction of 25 to 50 percent in the costs associated with avoidable complications by providing higher-quality, more collaborative care. Implementing ECRs would increase quality, decrease cost, and in the emerging trend of patient centered care can aid in patients constructing value indexes without eliminating choices.