233236 A SWOT Analysis of Evidence-Based Case Rates (ECRs): A promising new U.S. payment model for improving health care cost effectiveness and quality

Tuesday, November 9, 2010

Vanessa Rubano, MPH , Clinical Pharmacokinetics, Boehringer Ingelheim, Ridgefield, CT
Donna Pearce, MD, MS, RN, MPH Candidate Mailman School of Public Health , Anesthesiologist / Healthcare Policy and Management Student, Columbia U Affiliation at Harlem Hospital Center/ Mailman School of Public Health, New York, NY
Christina Hope DiGioia, MPH , Healthcare Policy and Management, Mailman School of Public Health, New York, NY
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.

Learning Objectives:
Identify Healthcare management challenges: key stakeholders,legal & regulatory affairs, healthcare finance, managed care, quality/cost, and emerging trends. Examine current events in the healthcare industry and the various perspectives of key healthcare stakeholders and their dynamic roles and impact on the healthcare delivery system.

Keywords: Managed Care, Health Care Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: am qualified to present because my expertise lies in data modeling, analysis and reporting. Additionally I am a student at Columbia University's Mailman School of public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.