A Look at Blue Cross Blue Shield’s Alternative Quality Contract

Campaign for Better CareWhen Blue Cross and Blue Shield (BCBS) began its “Alternative Quality Contract,” to move from a fee-for-service system to one that pays practices a fixed sum for each patient’s care, patients questioned how this would impact care. Would this experiment truly improve quality? Would it actually reduce costs?

Today, economist and business consultant Ed Moscovitch penned an op-ed for the Boston Herald detailing his review of global payments to three AQC practices. How did they do? Well, Moscovitch concluded that if you change the way the money flows, you can change behaviors.

Under the global payment structure, docs are paid a set amount of money for each patient they care for, rather than for each procedure or test they provide. So, the providers have incentive to increase efficiency and better coordinate care between nurses, primary care physicians (PCPs) and specialists. Moscovitch notes that this new payment structure has been boon for patients at these hospitals. He writes:

Each of these groups has built an extensive network of nurses and data people to help doctors make sure patients get needed care. This includes making sure primary care physicians (PCP) know when patients use the emergency room, are admitted to the hospital or see specialists — and making sure that the PCP follows up quickly.

Blue Cross collects data on 18 quality measures, including patient blood sugar, blood pressure and cholesterol, whether patients receive timely mammograms and colonoscopies, and how satisfied patients are with their care.

The six participating medical groups scored far higher on these measures than other providers in their first year; their rate of improvement on monitoring for diabetes and cardiovascular disease was more than four times what they’d accomplished prior to the contract!

Tomorrow, Governor Patrick is expected to shed light on his plan to restructure the way we pay for health care in Massachusetts. We are hopeful his payment reform plan will yield healthier outcomes and better quality care for all Massachusetts – much like these hospitals have done.
-Victoria A. Bonney

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