McKesson First To Automate New Version Of PROMETHEUS Episodes For Bundling Claims

New Content Helps Payers and Providers Run Value-Based Programs at Scale 

Recently McKesson Episode Management released 22 new episodes based on the industry leading PROMETHEUS Payment  Evidence Informed Case Rate (ECR) definitions. This makes McKesson Episode Management the first automated bundled payment solution to support the latest PROMETHEUS model. This will help payers move from small pilots to full-scale programs by enabling the automation of fee-for-service claim bundling for fast and correct adjudication and payment.

The 22 episodes represent approximately 35 percent of commercial payers’ healthcare spend¹ and are the first milestone to arise from a previously announced partnership between McKesson and the Health Care Incentives Improvement Institute (HCI3) to advance adoption of healthcare payment reform. The episodes are also the first in a planned series of PROMETHEUS ECRs intended to cover up to 80 percent of U.S. medical spend.

This first content release covers a significant range of episodes appropriate for bundling, including procedural episodes like hip replacement, angioplasty and endoscopy; acute medical events such as stroke, heart attack and pneumonia; chronic conditions including diabetes, congestive heart failure and coronary artery disease; and obstetrical episodes such as pregnancy, normal delivery and c-section.

“Now healthcare organizations can scale value-based programs to promote quality care and reduce administrative and medical costs,” said Carolyn Wukitch, Senior Vice President of McKesson Health Solutions. “We’re ready to help any health plan ramp-up bundled payment programs using PROMETHEUS so they can get the most value from the model. This significant increase in content is what our customers expect from the leader in claims payment management.

François de Brantes, executive director of HCI3, agrees: “With this next step in our partnership, McKesson and HCI3 are demonstrating that the PROMETHEUS model is suitable for health plans and healthcare providers of all sizes and can reliably scale from the smallest pilot to the largest bundled payment program. We’re thrilled to be working with an industry leader like McKesson, who can automate what we believe to be is the best episode of care model in a practical way.

PROMETHEUS bundles payment for an episode of medical care that includes all patient services related to an illness or condition. It’s an evidence and value-based model designed to help employers, payers, and providers work together to increase efficiency and pay for the quality, not quantity, of care. By bundling payment, care is better coordinated among physicians, hospitals and other providers.

McKesson Episode Management is a configurable rules-based solution for automating bundled payments. It combines clinical dashboards and claims transaction functions to help support bundled payment programs at scale, promote quality care, and reduce administrative and medical costs. McKesson Episode Management can use any episode model, including PROMETHEUS or custom programs. The solution is powered by McKesson Total Payment, which leading health plans rely on to automate and ensure accuracy of claims payments for more than 100 million covered members.

For more information, visit Web site (http://www.mckesson.com/about-mckesson/our-company/businesses/mckesson-health-solutions/mckesson-health-solutions/).

About McKesson Corporation
McKesson Corporation, currently ranked 14th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology and business and clinical services. For more information,  visit  www.mckesson.com.

¹ “That was Then, This is Now. The Progression of PROMETHEUS Payment,” November 10, 2011, Health Care Incentives Improvement Institute.