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Quality Care

Quality Care Advantage: What Is It?

By placing more emphasis on doctor accountability and improving patient care outcomes, we've laid the groundwork for a shift from a fee-for-service model to a results-driven model focused on improving care coordination and patient health. The following sections detail our journey to bring real change to health care, and produce real solutions for our millions of members throughout Massachusetts and the country.

Spending more, earning less

For years, our nation's health care spending outpaced family earning gains and economic growth. States were affected individually, but as a country, it was evident that our health care system had a spending problem.

This economic trend drove us to developing real solutions that directly address this challenge.

The financial pinch is on for all of us

Rising health care costs squeezed needed funds from private and public sectors in states across the country. This financial pinch affected a state's ability to pay for priorities like police, fire safety, road repair, and other forms of critical infrastructure.

In our home state of Massachusetts, public health care spending led to a significant decrease in priority project funding.

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How Is Blue Cross Leading Health Care Reform?

Leveraging our past success into PPO expansion

In 2016, we expanded all of our commercial products, which included extending the tenets of the Quality Care Advantage to our PPO network. This means that no matter where our PPO members seek care, locally or nationally, they'll have access to high-quality doctors and hospitals that place an unprecedented emphasis on accountability, improving the continuum of care, and leveraging advanced analytics for greater insight into their patients' total health.

Our Quality Care Advantage cultivates stronger relationships between all participants in the care process. The result is our members can enjoy cost-savings, targeted and informed care, better care outcomes, and highly personalized, customized care.

Locally-grown quality with national impact

The success of the AQC in Massachusetts led us to developing a nationwide PPO model that brings the core elements of the AQC — collaboration, accountability, and personalized care — to our PPO members in other states.

Leveraging the power of Blue to deliver real solutions

Our ties with providers, and the fact that we have the largest market share out of all health insurers, allows us to innovate and influence the evolution of a critical industry on an unprecedented scale.

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Quality Care Advantage: How It Works

Partnerships for comprehensive care

The Quality Care Advantage gives doctors deeper insight into a patient's life, and uses actionable data to support the development of comprehensive care plans that improve our members' total health.

An example of the Quality Care Advantage

Before our reform, the burdens of care coordination and maximizing the value of a health plan were the patient's responsibility. With Blue Cross, patients have a stronger relationship with their personal doctor, and their care is effortlessly coordinated, simple, and easy to access. Below is a brief example of our Quality Care Advantage in action for our members.

A picture of total health

Our collaborative model is the proven conduit to health care that works better.

Experts agree: We're driving lower costs for employers

Savings on medical spending1

Harvard Medical School tested our AQC against a control group, and found that between 2009-2012, it created significant health care cost savings, ultimately resulting in a 10% increase in savings over a four-year period.

Slowing cost trends1

Under our model, we're showing significantly better trends than our other major competitors in Massachusetts. Additional validation was derived from the 2015 Massachusetts Health Care Cost Trend Hearing.

Real results from real change

Our quality care advantage has been tested, and year-over-year is returning promising results Below are a few examples of the Quality Care Advantage's impact:

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What Does the Quality Care Advantage Mean for Employers?

Better care for employees, better bottom line for you

We've provided the necessary changes to how health care works, with a renewed focus on keeping your employees healthy, engaged, productive, and best of all — at work. At the heart of this revolution in health care is our unique Blue Cross Blue Shield member data and advanced analytics.

We share this data and the insight gleaned from our advanced analytics with doctors, granting them an unprecedented, holistic view of their patient's lives and activity outside of their doctor's office.

The results — access to better coordinated care for your employees, and a healthier workforce in conjunction with lower health care costs for your business.

What does this all mean?

When it comes to choosing a health insurance partner, it helps to know that Blue Cross Blue Shield has the local and national strength necessary to innovate, execute, and expand real change that leads to sweeping health care reform on a national level.

The job of changing health for the better isn't done, but neither are we.

We're poised to expand our previous success, bringing better health care to millions of our members nationwide.

Alternative Quality Contract

We believe that doctors and hospitals should be rewarded for delivering high-quality patient care and for helping to keep our members healthy.

See what others are saying about our Alternative Quality Contract:

A new 2015 paper by Avalere highlights that multiple peer-reviewed studies show that the AQC can reduce spending growth while improving quality of care. The report encourages health care leaders and policymakers to examine models like the AQC.

Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract


"The study — by researchers at Harvard Medical School and funded by the Commonwealth Fund and the National Institute on Aging — compares 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)."

New Study in the New England Journal of Medicine Finds Blue Cross Alternative Quality Contract Lowers Costs and Improves Patient Care


Lowell General Physician Hospital Organization Lowell General Physician Hospital Organization

Lowell General Physician Hospital Organization talks about their experience with the AQC.

Northeast Physician Hospital Association Northeast Physician Hospital Association

The Northeast Physician Hospital Association Medical Director talks about their experience with the AQC.

Children's Hospital Children's Hospital

Children's Hospital Boston talks about their experience with the AQC.

Atrius Health Atrius Health

Atrius Health talks about their experience with the AQC.


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