A Blue Cross Blue Shield of Massachusetts (Blue Cross) Alternative Quality Contract (AQC) improved quality of patient care and lowered costs in the four years since it was implemented, according to an independent study by Harvard Medical School published in the New England Journal of Medicine (NEJM).
The study compared Blue Cross members with a primary care physician (PCP) in an AQC contract with a control group comprised of commercially insured individuals across eight northeastern states: Connecticut, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
Researchers found Massachusetts AQC enrollees had lower spending growth and greater quality improvements that were significantly higher than national averages. Quality improvements included preventive care for healthy children and adults as well as improvements in the management of serious chronic illnesses.
According to Blue Cross, the AQC is an innovative payment reform that focuses on promoting quality and rewards positive health outcomes. About 85 percent of the physicians and hospitals in the Blue Cross HMO network are part of it, and it is the predominant contract model between Blue Cross and its network physicians and hospitals. The alternative payment model fosters shared responsibility for both improving care and moderating the unsustainable rate of increase in healthcare costs.
To be successful in managing outcomes, providers have to engage differently with patients and understand the factors in their day-to-day lives that could get in the way of successfully managing their diabetes, hypertension or heart disease, and help patients develop ways to overcome those barriers, Blue Cross officials said.
The study found the savings achieved by the AQC groups accelerated year by year. In the initial year, savings were approximately two percent compared to the control group, while by year four, the AQC groups saved 10 percent compared to control group. Savings were concentrated in the outpatient setting and explained by providers increasingly using lower cost settings and by reduced utilization, including discretionary procedures, imaging and testing.
Source: Blue Cross Blue Shield of Massachusetts , October 30, 2014
Driving Value-Based Reimbursement with Integrated Care Models examines WellPoint’s practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.