PROMETHEUS finding opportunity and making it actionable Shane

PROMETHEUS: finding opportunity and making it actionable. Shane Mofford – Director of Rates and Payment Reform 10/12/2018 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

Overview • Medicaid landscape • What is PROMETHEUS? • See it in action! • The future and next steps 3

The Medicaid Landscape - The Pressure is on! *State and national pressure to demonstrate value – drive towards alternative payment methodologies *Tight budget in Colorado – TABOR *Changes in leadership This Photo by Unknown Author is licensed under CC BY-SA-NC *Continually evolving population needs 4

Department response to the pressure? *Continually driving improvements to the Medicaid delivery system platform, the Accountable Care Collaborative (ACC Phase II) *Payment reform: Hospital, Primary Care, Federally Qualified Health Centers, Specialists, and Behavioral Health *Redefining the payer/provider relationship *Focus on internal performance improvement *Investment in analytics and technology (Today’s Discussion) 5

What is PROMETHEUS? Analytical tool that groups medical claims into ‘episodes of care’ based on a clinically defined algorithm. Originally designed as a tool for bundled payments. 6

Episodes of Care Clinically related services for the treatment of a specific condition Services are designated as either typical or potentially avoidable Trigger Event Related Preoperative Care Related Postoperative Care Physician visit, imaging, medication, ER visit, Inpatient admission for infection Physician visit, imaging Knee Surgery 7

Types of Episodes – Over 90 different clinical episodes • Chronic (including behavioral health) • System Related Failure • Acute • Procedural • Other 8

Time for a bold experiment. To the tool! 9

Questions and further discussion? 10

Contact Information Shane Mofford Director of Rates and Payment Reform Shane. Mofford@state. co. us 11

Thank You! 12