Making Quality Health Care Affordable

Payment Reform
One way we're working to make quality health care affordable is by changing how we pay for the health care services our members receive. For many years, health plans like Blue Cross Blue Shield of Massachusetts, have paid doctors and hospitals a fee for every test, procedure or other service they perform. This system rewards quantity of care—not necessarily better care. We believe that doctors and hospitals should be paid for the quality and outcome of patients' care.

Our new approach to paying for health care promotes improved patient care and slows the rise in health care costs. Called the Alternative Quality Contract (AQC), doctors and hospitals are paid for the quality, not just the quantity of the care they provide to our members. It rewards doctors and hospitals for keeping patients healthy and for effectively managing chronic illnesses. Read more about the AQC.

AQC Results
First year results show this new payment approach is achieving both quality and cost goals. Provider organizations operating under the AQC for a full year have shown greater improvements in quality than during any one-year period previously seen, significantly exceeding the rates of improvement on quality measures they were achieving prior to the AQC. Regarding costs, the first year results show that we are on track to achieve our target to reduce annual cost trends by one-half over five years. Read more about what AQC providers have accomplished in the first full year of the contract.

In the videos below, representatives of Atrius Health, Accountable Care Associates in Hampden County, Massachusetts, and Lowell General Physician Hospital Organization talk about their experiences with the Alternative Quality Contract (AQC). They agree the AQC is helping them provide higher quality and more affordable care.

To support the efforts of doctors and hospitals that have signed the AQC, Blue Cross Blue Shield of Massachusetts is collaborating with our AQC providers in new ways. One way is a seven-month seminar series, which we sponsor, to help health care leaders further develop the skills needed to better manage their organizations and lead the change necessary to thrive under this new contract.

In this video, Dana Safran, Senior Vice President for Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts, talks about how doctors and hospitals are improving the quality of patient care under the AQC.

Dana was recently invited to testify at the Ways and Means Health Subcommittee hearing in Washington, D.C. on May 12, 2011. Dana spoke about the AQC, an example of an innovative reform model, which was of interest to the Subcommittee.

Our AQC Partners
Since we introduced the AQC in 2008, a number of pioneering physicians' practices and hospitals have agreed to partner with us in this innovative model, including:

• Atrius Health
• Beth Israel Deaconess Physician Organization
• Caritas Christi Health Care
• Mount Auburn Hospital and its affiliated physician group, Mount Auburn Cambridge Independent Practice Association, Inc
• Lowell General Hospital and its affiliated physicians in the Lowell General Physician Hospital Organization
• Hampden County Physician Associates
• Northeast Physician Hospital Organization
• Signature Healthcare Corporation—Brockton, Massachusetts
• Tufts Medical Center and its network of affiliated physicians, the New England Quality Care Alliance