Evidence-Informed Case Rates: Paying for Safer, More Reliable Care

There is widespread dissatisfaction with the current modes of paying for health care. Created by Prometheus Payment, evidence-informed case rates (ECRs) are designed to create fair payments for all providers delivering care to a patient for a particular condition. ECRs would combine global fees with an allowance for complications and performance incentives. The authors model ECRs for two scenarios, acute myocardial infarction and diabetes. Their analysis shows that, under fee-for-service payments, a high proportion of the costs of care go toward potentially avoidable complications—some 30 percent of payments for acute myocardial infarctions and 60 percent of payment for diabetes care.They conclude that ECRs would hold the delivery system accountable for the technical risk it imputes on the total costs of care—for medical errors and potentially avoidable complications. Further, ECRs would create incentives for providers to deliver care that is safer, more reliable, and consistent with evidence-based guidelines.