Boston Area Medical Centers Join Blue Cross Blue Shield AQC Plan

BOSTON — The Boston Medical Center and seven affiliated health centers will join Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (AQC), which aims to promote the quality of care over the number of services provided.

Blue Cross Blue Shield established the contracts in January 2009 as a result of concerns with the fee-for-service reimbursement model, which, according to the health care network, unintentionally rewards doctors and hospitals for the quantity and complexity of services provided rather than the quality and outcomes of care.

“Fee-for-service payments create incentives to provide more and more services, even when there may be better, lower-cost ways to treat a condition,” said Karen Davis, president of the Commonwealth Fund. “It’s not realistic to tell hospitals and doctors that they must improve quality if by doing so they are likely to lose money.”

In an effort to address the concerns while balancing financial goals, the Blue Cross Blue Shield team came up with the Alternative Quality Contract, a global payment model that combines a fixed per-patient payment with substantial performance incentive payments.

In a statement, Blue Cross Blue Shield of Massachusetts described the goal of the setup as “to enable the delivery system to give the patient the best result from the most appropriate treatment, by the right kind of provider, at the right, and in the most appropriate setting.”

Under the five-year budget-based agreement, the Boston Medical Center will manage the growth in health care spending to a level that falls below BCBSMA’s network average expense trend.

The center works with a network of community health centers in Boston, including seven that will participate in the AQC contract: Codman Square Health Center, Dorchester House Multi-Service Center, East Boston Neighborhood Health Center, Greater Roslindale Medical & Dental Center, South Boston Community Health Center, South End Community Health Center and Upham’s Corner Health Center.

The AQC contract will also include Boston Medical Center’s community-based primary care physicians who are part of the Boston University Affiliated Physicians group, which has practices in Boston’s Back Bay and South End, Foxboro, Norwood and Taunton.

The agreement brings into the AQC nearly 800 additional physicians who care for about 13,000 of BCBSMA’s in-state HMO members. In other words, about two-thirds of doctors in BCBSMA’s in-state HMO network provide care to about 76 percent of BCBSMA members.

An independent study conducted by the Harvard Medical School and Brandeis University, published in the New England Journal of Medicine and Health Affairs, found the contract appears to be achieving its twin goals of improving care and slowing costs particularly in managing chronic illness, preventive care screenings and treating depression.

The studies found that in the first year of AQC, medical spending was nearly 2 percent lower among participating physicians and hospitals compared with those working in traditional fee-for-service contracts.

For physicians and hospitals with no previous experience in a global payment model, spending was 6 percent lower than that of providers in traditional fee-for-service contracts, researchers found.

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