accountable care organizations, AQC, Blue Cross Blue Shield Alternative Quality Contract, bonus payments, Boston Magazine, Boston Schweitzer Fellows Program, Brookside Community Health Center, economics, Harvard, health policy, impact, intervention, MA Health Care Quality and Cost Council, Massachusetts, payment reform, quality of care, referral patterns, Zirui Song
You may remember Schweitzer Fellow for Life Zirui Song from his selection last year as one of Boston Magazine’s top emerging doctors, or from his participation in our earlier “Fellows Weigh in on Health Care Reform” blog series.
Now, the MD/PhD student in the economics track of Harvard’s health policy program has been published in the New England Journal of Medicine.
“The paper is about payment reform for doctors and hospitals in Massachusetts,” says Song. “It’s an initial evaluation of the Blue Cross Blue Shield Alternative Quality Contract (AQC), which was implemented in 2009. The contract pays physician groups a global budget to take care of their patients (instead of a separate fee for each service) and bonus payments for quality of care. The arrangement is similar to accountable care organizations proposed by the health care reform legislation. We compared spending and quality differences between physicians groups in the AQC and groups not in the AQC, both before and after the payment reform, to get an idea of the intervention’s impact.”
Song’s evaluation found that:
The AQC was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC on spending growth depends on future budget targets and providers’ ability to further improve efficiencies in practice.
These findings differ somewhat from those in the recently-released Massachusetts Attorney General’s report, which also looks at the AQC. The findings will be discussed at a public August 17th meeting of the MA Health Care Quality and Cost Council. The Council has taken up the issue of payment reform in MA after a state commission voted in 2009 to move the state towards global payment within 5 years.
Song—who as a Boston Schweitzer Fellow in 2007-8 helped the Brookside Community Health Center set up a sports and nutrition education program for kids—continues to work toward improved health care for underserved people.
“We should be careful to not generalize the findings outside of the study population, which is adults with employer-sponsored health insurance,” he says. “However, it is worth noting that at a time when state Medicaid programs are suffering from budget shortfalls and the underserved are facing either cuts to their Medicaid benefits or increases in their share of out-of-pocket costs, policies that reduce health care spending while improving quality are needed. The same goes for Medicare. Saving the health care system dollars by improving the efficiency of care delivery would be more agreeable for most stakeholders than the alternative of cutting benefits to patients or cutting payments to providers. Studies like this might be baby steps towards figuring out a solution, but at the moment we have a long way to go.”
Intrigued by Song’s perspective on health care and the findings he published in the NEJM? Talk with him in person by registering for ASF’s 5th Annual Fellows for Life Conference: Achieving Health Equity together, where Song will participate in a panel on health care reform and its implications.