- Joined
- Aug 10, 2013
- Messages
- 20,229
- Reaction score
- 21,623
- Location
- Cambridge, MA
- Gender
- Male
- Political Leaning
- Slightly Liberal
A decade ago, Blue Cross Blue Shield of Massachusetts started an experiment to change the financial incentives health care providers face. That approach has since gone national, as it was built into the reforms passed in the Affordable Care Act the following year. The latest results from the experiment in Massachusetts show impressive results in the first eight years:
A little more context from recent media coverage:
Changing The Way Doctors Are Paid Made Patients Healthier And Saved Money, Study Finds
BCBSMA's Andy Dreyfus takes a victory lap: ‘Meticulous’ study shows that value-based care works
During the 8-year post-intervention period from 2009 to 2016, the increase in the average annual medical spending on claims for the enrollees in organizations that entered the AQC in 2009 was $461 lower per enrollee than spending in the control states (P<0.001), an 11.7% relative savings on claims. Savings on claims were driven in the early years by lower prices and in the later years by lower utilization of services, including use of laboratory testing, certain imaging tests, and emergency department visits. Most quality measures of processes and outcomes improved more in the AQC cohorts than they did in New England and the nation in unadjusted analyses.
A little more context from recent media coverage:
Changing The Way Doctors Are Paid Made Patients Healthier And Saved Money, Study Finds
The program, called the Alternative Quality Contract, works in two key ways. First, health care providers like Atrius Health, which joined in 2009, received bonuses to pay for upgrades at their medical practices like additional staff and improved electronic medical records.
“That allows us to invest in infrastructure and connect better with our patients and do a better job,” Strongwater says. “The goal [of that] is to keep patients healthier through prevention and early intervention.”
The idea, he says, is that healthier patients cost the system less overall.
The second part of the program changed how doctors, hospitals and other providers are paid. In a typical health payment system, providers receive payments for each service they perform, but Blue Cross Blue Shield’s new program uses a different system, known as a global payment model.
In this system, primary care providers receive a spending target from Blue Cross Blue Shield for their members’ care. If they spend less than the target amount by the end of the year, the providers and the health insurance company split the cash. If the doctors overspend, they and insurer split the extra cost.
The theory is that this will encourage physicians to take extra steps to avoid expensive care like emergency room visits and hospital stays.
BCBSMA's Andy Dreyfus takes a victory lap: ‘Meticulous’ study shows that value-based care works
The researchers saw smaller growth in average annual medical spending on claims for the Blue Cross Blue Shield members than for those in other states, with savings deepening over time, up to 12%. At the same time, patients cared for under the AQC model received better preventive care compared to the control group and achieved better management of chronic illnesses such as diabetes and high blood pressure. . . Unnecessary emergency room visits dropped, as did unneeded imaging.
A decade ago, Blue Cross Blue Shield of Massachusetts started talking with local physicians about alternatives to traditional fee-for-service payment. Many told us they would welcome financial incentives to do what was best for their patients, not what was most costly. Under the AQC model that we developed with their insights, physicians receive a global budget for each member’s care, with incentives tied to quality improvement and savings.
Health care delivery is far too complex for incentives alone to bring about systemic improvements in quality, efficiency, and effectiveness. Physicians also need information they can act on. We provide AQC physicians with weekly, monthly, and yearly data reports and analytics, including how they’re doing on quality measures, how satisfied their patients are with their care, and where their greatest opportunities for improvement may be in areas ranging from prescriptions to cost trends to emergency department use. We also arrange forums for groups of physicians to share their best practices.