Over the coming months, the Department will be rolling out a suite of powerful cost and quality assessment capabilities to the seven Regional Accountable Entities (RAEs), hospitals and primary care providers. The new Prometheus tool will identify Potentially Avoidable Costs (PACs) on member care, which can then be rolled up to identify opportunities at the individual physician, primary care medical home, specialist and hospital levels.
Prometheus will also enable providers to improve their referral patterns towards more cost effective, quality physicians and hospitals. It can further enable hospitals to identify and self-correct inefficient, lower quality care delivery. RAEs can use it to target members for care management. The Department will also empower it to drive members seeking provider locator services to higher performing providers.
Upon the unanimous approval of SB 18-266 the Department is also releasing a Request for Information for the development of a new Prescription Drug Prescribing Tool to be used by physicians. Payers and providers will benefit from the use of a shared prescribing tool that loads all the prescription drug reimbursements, plan designs, and copays by carrier into a single tool that connects to the patient's electronic medical record (EMR). The tool then employs all those facts to provide the physician with insights into the most efficacious prescription to prescribe to each patient. The Department is working closely with stakeholders to draft the Request for Information to ensure the tool is developed with the input of our provider and payer partners.
Ultimately, prescribing physicians will have one tool that incorporates the insights from their patients' medical condition, their Rx plan design and formulary to enable more efficacious prescribing patterns. To physicians and providers, this also drives increases Value Based Performance Payments while improving quality care. To carriers, cost performance and quality outcomes improve.
The Department will continue to share updates as the development of these cost saving person-centered tools of transformation progress.