Anatomy of a GlobalPRIME™ Payment

A GlobalPRIME™ Payment has four principal components: reimbursement for required costs, payment for personalized costs, margin, and a warranty. Adjustments are made to required costs, personalized costs, and the warranty to reflect increased costs associated with the care of sicker or more complex patients.

The components and their respective adjustments are combined into a single payment amount.

• Required Costs

  Covers the cost of episode-specific services required by all patients, based on scientific evidence and professional consensus.

• Adjustment of Required Costs

  Covers the cost for additional services required to care for a patient based on severity and complexity or, for Routine and Preventive Care, patient characteristics (e.g. age, gender, pre-existing conditions)

• Personalized Costs

  Covers the cost of all additional services, each of which is reasonably employed in the care of an episode, derived empirically from the experience of providers of effective, efficient care.

• Adjustment of Personalized Costs

  Covers additional costs associated with increased severity and complexity.

• Margin

  Covers general operating overhead and the value added by a provider, calculated as a percentage of the total required and personalized costs.

• Warranty

  Covers the cost of adverse outcomes, based on the experience of effective, efficient providers, for which a provider assumes responsibility.

• Adjustment of Warranty

  Covers costs associated with additional risk of adverse outcomes.

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• Required Costs

  Covers the cost of episode-specific services required by all patients, based on scientific evidence and professional consensus.

• Adjustment of Required Costs

  Covers the cost for additional services required to care for a patient based on severity and complexity or, for Routine and Preventive Care, patient characteristics (e.g. age, gender, pre-existing conditions)

• Personalized Costs

  Covers the cost of all additional services, each of which is reasonably employed in the care of an episode, derived empirically from the experience of providers of effective, efficient care.

• Adjustment of Personalized Costs

  Covers additional costs associated with increased severity and complexity.

• Margin

  Covers general operating overhead and the value added by a provider, calculated as a percentage of the total required and personalized costs.

• Warranty

  Covers the cost of adverse outcomes, based on the experience of effective, efficient providers, for which a provider assumes responsibility.

• Adjustment of Warranty

  Covers costs associated with additional risk of adverse outcomes.