AQC Improves Affordability While Redefining Provider Experience, Care Delivery
Our Alternative Quality Contract (AQC) payment model continues to have a
significant impact on efforts to increase both the quality and affordability of
health care in Massachusetts. A recent analysis by BCBSMA of year three of our
Alternative Quality Contract (AQC) payment model indicates that we are on track
to reach our goal of reducing annual health care cost growth trends by half over
Moreover, we have consistently heard from many members of the health care community that the AQC's aligned quality and efficiency incentives create an environment that fosters more communication, coordination, and integration between primary care providers and specialists, and between physician groups and participating hospitals. The new environment created by the collaborative payment model seems to be increasing innovation and changing the way providers deliver care.
Our preliminary analysis shows that AQC groups either maintained or improved their performance on patient experience and outcome measures.
Groups that have been operating under AQC since 2009 continue to improve quality and outcomes—sometimes approaching "best achievable" performance.
Groups that began using the AQC model in 2010 also continue to make strides, with specific success in chronic care management in 2011.
Groups that began using the AQC in 2011 performed significantly better on ambulatory process measures compared to non-AQC providers.
Our analysis shows the AQC is also significantly slowing the rate of increase in spending, compared to groups that do not participate in the AQC. This is consistent with results that an independent analysis of the AQC by Harvard researchers found in 2012. That study revealed that participation in the contract over two years led to savings of 1.9 percent in year one and 3.3 percent in year two compared to spending in non-participating groups. Savings were substantially larger in the groups that had no experience with risk-based contracts—6.3 percent in year one and 9.9 percent in year two.
In 2011, we found that AQC groups' savings were generated in two key areas:
Improved use of healthcare - AQC groups had fewer inpatient admissions, resulting in claim savings of over $10 million and more than $400,000 in avoided member cost-share. AQC groups also used less high-tech radiology (MRI, CTs, nuclear medicine) than non-AQC groups, resulting in $3.3 million in avoided claim costs and over $300,000 in avoided member cost-share.
Site of service changes - AQC groups started to move outpatient surgeries and procedures such as colonoscopies from hospitals to less-costly facilities, resulting in claim savings over the length of the contracts of an estimated $6.5 million in claim costs.
Perhaps most notably, anecdotal evidence shows that the global budget model facilitates sweeping changes in the culture of most groups, including changes in roles and responsibilities. According to interviews of physician leaders, primary care providers, and specialists at all types of AQC groups, large and small, physicians are now working in teams with non-physicians (pharmacists, case managers, nurse practitioners, and diabetes educators, for example) who take on increased responsibility for patient contact and clinical decision-making.
Among the most common examples of the types of sustainable changes in the way groups and individuals practice that interviewees cited were these:
More attention is paid to quality indicators, transitions of care, preventable complications, and variations in practice related to overuse, underuse, or misuse of tests and procedures.
Groups understand the value of dedicating resources to build new infrastructure and information systems; employ more nurses and medical assistants; offer patients extra preventive care, rehabilitation care, and consultation about medication use.
Physicians spend more time trying to help patients get their care in the most appropriate setting, and explaining their recommendations to patients.
You can read about specific ways groups are innovating on our AQC website.
We look forward to continuing to innovate with our provider organization partners to achieve a high-performance health care system with a sustainable rate of spending growth. At the same time, we recognize that the AQC is only one important part of our broader strategy to make quality health care more affordable for members, employers, and the broader community. Other key components are consumer-driven health insurance plans that engage members in choosing low-cost, high-quality providers and continued emphasis ways that we can improve the health and wellness of our members.