Many health systems today are taking steps to become accountable care organizations
(ACOs). In doing so, they are seeking to enhance each patient’s
experience of care, to improve the health of the population, and to cut
costs. This “triple aim” of health care redesign is being
used widely across the nation and is one of the reasons CaroMont Health
has developed a collaborative arrangement with Blue Cross and Blue Shield
of North Carolina (BCBSNC), the state’s largest health insurer,
to offer a new way to deliver and pay for care for those patients needing
knee replacement surgery.
Under this value-based initiative, BCBSNC is using the PROMETHEUS Payment
model from the Health Care Incentives Improvement Institute (HCI3). Introduced
in April, this initiative is designed to cover the entire knee replacement,
including the pre-surgical period of 30 days before hospitalization, the
surgery itself, and most follow-up care within 180-days after discharge.
Implementing the PROMETHEUS model is important for three reasons. First,
BCBSNC and CaroMont believe care redesign must accompany payment structure
redesign and that health systems and health plans should have programs
to meet the triple aim objectives.
The second reason PROMETHEUS is significant is that administrators of BCBSNC
and CaroMont worked closely with the clinical staff to implement this
payment model. Although our clinicians are independent community physicians,
they have been leading the development of this program. As a result of
their leadership, we have aligned ourselves around what’s best for
“Collaboration with providers that eliminates fragmentation in the
way care is provided and paid for—and promotes better outcomes in
the process—is our priority at Blue Cross,” said BCBSNC President
and CEO Brad Wilson. “We believe initiatives like this one at CaroMont
are key to promoting health care quality, while also holding down costs.”
The third reason the PROMETHEUS model is important is that it is a step
toward becoming an ACO and demonstrates how CaroMont Health and BCBSNC
are responding to economic challenges and health reform legislation.
Over the full episode of care required for knee replacement, the PROMETHEUS
model involves implementing cost-effective initiatives that cover both
hospital and physician services. By paying for care over 210 days, this
model is longer than other bundled payment models for knee replacement,
one of which covers only the cost of the surgery itself and a three-day
But here at CaroMont, we think bundled payments should cover a broader
definition of care. Health systems can embark on innovative pilot programs
for coordinated care to reduce the cost of care and improve the patient
experience and patient outcomes. We must be willing to take responsibility
for the full episode of care, meaning even after patients leave the hospital.
This bundled knee replacement program is an extension of CaroMont’s
vision and mission. As a community health system, we take seriously our
mission of creating vibrant communities where we live and work. BCBSNC
has recognized our commitment to quality care by designating CaroMont
as one of six providers in North Carolina that is a Blue Distinction Center
for Hip and Knee Replacement, Spine Surgery, and Cardiac Care.
In addition, even though CaroMont and BCBSNC worked with HCI3 to implement
this program, it extends to all independent licensed Blue Cross plans
nationwide. That means a member of any Blue Cross national plan can come
to CaroMont Health for the excellent care we provide.
By next spring, we will evaluate our results and consider adopting this
model for other clinical conditions and perhaps extending this pilot beyond
the first 12 months. In the meantime, as we improve the way care is delivered
and paid for, providers and payers must act as true partners to be accountable
and to deliver coordinated care for our communities. That is a hallmark
of the relationship between BCBSNC and CaroMont Health: We are acting
as true partners.
Betty Herbert leads managed care strategy and performance for CaroMont
Health in North Carolina. She can be reached at