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Blue Cross Blue Shield of Massachusetts and Caritas Christi Health Care Sign Alternative Quality Contract

CONTACT: Tara Murray
(617) 246-4851
Tara.Murray@bcbsma.com

BOSTON — November 27, 2009 — Blue Cross Blue Shield of Massachusetts, Inc. and Caritas Christi Health Care today announced they signed a new five-year Alternative Quality Contract(AQC). The agreement continues momentum of the adoption of this global payment system coupled with quality-based incentives designed to improve the quality and affordability of health care.

The contract with Caritas Christi Health Care, the largest community-based hospital network in New England, includes approximately 1,100 physicians affecting close to 60,000 BCBSMA members and brings the highest number of physicians from any organization into the AQC to date. With the addition of Caritas Christi, 20 percent of BCBSMA's provider network is now in the AQC - providing care for more than a quarter of BCBSMA's Massachusetts-based HMO members.

Caritas Christi Health Care and Caritas Christi Network Services, the 10th largest employer in the Commonwealth, is comprised of over 400 physician sites and six hospitals: Carney Hospital in Dorchester, Good Samaritan Medical Center in Brockton, Holy Family Hospital in Methuen, Norwood Hospital in Norwood, Saint Anne's Hospital in Fall River, and St. Elizabeth's Medical Center in Brighton. The AQC is a significant change from traditional fee-for-service contracts and gives physicians the flexibility to allocate health care resources based on what will have the greatest benefits to patient health. Under the AQC, Caritas Christi will increase its focus on preventative care while optimizing quality and access. In order to maximize the potential of the AQC model for the benefit of its diverse patient population, Caritas Christi has overhauled several corporate structures as well as made key strategic partnerships and investments. Investments include the implementation of an electronic health system, capital investments, and physician network development to increase quality of care and help reduce unnecessary costs.

"Entering into the AQC is absolutely the right thing for us to do," said Caritas CEO Ralph de la Torre, M.D. "Working within a controlled budget is a rational way to effectively manage costs, while still providing quality and increasing access to health care in our communities. Caritas is well positioned to manage this innovative type of relationship, since we are already known as a community-based system offering a high-value delivery system."

The AQC combines two forms of payment. The first is a global, or fixed, payment per patient adjusted for age, sex, and health status that increases annually in line with inflation. The second payment includes substantial performance incentives tied to the latest nationally accepted measures of quality, effectiveness, and patient experience of care. The contract's global payment covers all services received by a patient, including primary, specialty, and hospital care. So, when a doctor spends more time with a patient and helps the patient avoid an unnecessary hospitalization, the patient receives better care, the doctor and hospital have the potential to receive performance incentives, and the overall costs are less. The AQC is designed to improve the quality of care BCBSMA's members receive and significantly reduce current annual medical cost trends.

"The momentum of the AQC demonstrates that we are on the right track to improving the quality of care and slowing the growth of costs in Massachusetts," said Cleve Killingsworth, CEO of BCBSMA. "By signing the AQC, Caritas Christi is helping to improve the quality, safety, and affordability of health care in many communities throughout the Commonwealth."

AQC Momentum
Since January 2009, the following hospitals and provider groups have signed Alternative Quality Contracts: Mount Auburn Hospital and the affiliated Mount Auburn Cambridge Independent Practice Association (MACIPA); Hampden County Physician Associates, LLC (HCPA); Tufts Medical Center and the affiliated New England Quality Care Alliance (NEQCA); Signature Healthcare Corporation, including Brockton Hospital; Lowell General Hospital and the affiliated Lowell General Physician Hospital Organization; South Shore Hospital and the affiliated South Shore Physician Hospital Organization; Atrius Health; and Caritas Christi Health Care.

About Caritas Christi Health Care
With over 13,000 employees serving over 600,000 patients annually in 85 communities, Caritas Christi is the largest community-based health care system in New England and the 10th largest employer in Massachusetts. Further information is available at www.CaritasChristi.org.

 

Blue Cross Blue Shield of Massachusetts ( http://www.bluecrossma.com ) was founded more than 70 years ago by a group of community-minded business leaders. Today, headquartered in Boston, BCBSMA provides coverage to more than 3 million members, 2.5 million in Massachusetts. BCBSMA believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association.

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