Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
A look at strategies for lowering hospital readmissions across the continuum of care.
Hospital readmissions are a multi-dimensional problem. No single player or entity is entirely responsible for reducing excess readmissions. By improving our understanding of each touch point along the patient care continuum, strategies can be developed that ultimately reduce total readmissions.
This paper explores the roles of patients and providers in reducing readmissions and reviews several strategies that each can implement to help reduce readmission rates.
-Which patients are at high risk of hospital readmission?
-Comprehensive discharge planning strategies
-The physician’s role in lowering hospital readmission rates
-Optimizing communications handoffs between providers
-Building patient-centered transitional care models
-End of life planning
What are the hurdles to overcome in the transition from fee-for-service to value-based reimbursement? Is Value Based Care here to stay? Learn more from this slide-share on the differences between Value Based Care and Fee For Service.
What are the four conceptual templates for value based care? Is the compensation really worth it? We give you the answers here in this insightful slide-share.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
A look at strategies for lowering hospital readmissions across the continuum of care.
Hospital readmissions are a multi-dimensional problem. No single player or entity is entirely responsible for reducing excess readmissions. By improving our understanding of each touch point along the patient care continuum, strategies can be developed that ultimately reduce total readmissions.
This paper explores the roles of patients and providers in reducing readmissions and reviews several strategies that each can implement to help reduce readmission rates.
-Which patients are at high risk of hospital readmission?
-Comprehensive discharge planning strategies
-The physician’s role in lowering hospital readmission rates
-Optimizing communications handoffs between providers
-Building patient-centered transitional care models
-End of life planning
What are the hurdles to overcome in the transition from fee-for-service to value-based reimbursement? Is Value Based Care here to stay? Learn more from this slide-share on the differences between Value Based Care and Fee For Service.
What are the four conceptual templates for value based care? Is the compensation really worth it? We give you the answers here in this insightful slide-share.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Wondering how to grow your Pinterest following? Looking for better Pinterest engagement? In this presentation, Jeff Sieh (host of the Manly Pinterest Show) reveals the strategies he uses for Social Media Examiner and other clients to build a large and loyal community. You’ll leave with a daily checklist for growing a massive Pinterest audience and a plan for building trust in your community.
From your artwork to video promotions, Jeff Sieh shares how to maximize branding to set you apart from other podcasts in your niche. In this session he’ll cover:
People Rocking The Personal Brand
Drop The Flaming Mic! – Why you need to spend time on developing your artwork.
Branding Your Intro & Call To Action
How Video Ads & Promos Can Set You Apart
And Much More!
You won’t want to miss this session full of DIYs, tips, and examples YOU can use take your podcast brand to the next level.
mHealth Israel_Dr Dana Safran_Payment Reform Successes and Challenges_Nov 25,...Levi Shapiro
Presentation for mHealth Israel by Dr Dana Safran, SVP, Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts, about "Payment Reform Successes and Challenges", with an emphasis on lessons learned from their Alternative Quality Contract (AQC)
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
mHealth Israel_Dana Safran_Blue Cross Blue Shield_The Alternative Quality Con...Levi Shapiro
Presentation at the mHealth Israel Investors Summit, June 2015, by Dr. Dana Safran, Senior Vice President,
Performance Measurement and Improvement: "The Alternative Quality Contract (AQC): Improving Quality While Slowing Spending Growth"
The Medicare Advantage Value-Based Insurance Design Model team presented a webinar discussing the CY2020 application cycle on Friday, January 25 from 4:00 p.m. to 5:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The National Health Council conducted research, did an analysis, and prepared proposed regulatory language to assist the Secretary of Health and Human Services with the preparation of an essential health benefits (EHB) package that will serve the needs of people with chronic diseases and disabilities. This slide show is from a NHC briefing on EHB, given August 3, 2011.
Complete Evaluation of CMS ACO Reach Program.pptxPersivia Inc
In the ever-evolving landscape of healthcare, the Centers for Medicare & Medicaid Services (CMS) continually seek innovative ways to improve the quality and efficiency of care delivery. One such initiative that has garnered significant attention is the CMS ACO Reach.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
Who benefits most from the aco reach model – patients or healthcare providers...Persivia Inc
ACO has emerged today as a promising approach to improving the quality and efficiency of healthcare services. This innovative model raises an important question: Who stands to benefit the most from the ACO Reach Model - patients or healthcare providers? To answer this question, we'll delve into the intricacies of the program, exploring its key components and assessing the advantages it offers to both patients and healthcare providers.
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Similar to 1425335352_AH_WhitePaper_AQC_final (20)
Webinar: Medicare Advantage Value-Based Insurance Design Model - 2022 Request...
1425335352_AH_WhitePaper_AQC_final
1. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 1
Payment Reform on the Ground: Lessons from
the Blue Cross Blue Shield of Massachusetts
Alternative Quality Contract
March 2015
Prepared by:
Josh Seidman, PhD, Cara Kelly, MHS
Nelly Ganesan, MPH, Ashley Gray, MPP
Avalere Health LLC
2. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 2
TABLE OF CONTENTS
Acknowledgements 3
Executive Summary 5
About the Alternative Quality Contract (AQC) 6
Core Elements 7
Program Participation 7
Key Observations 8
Considerations for Future Initiatives 13
Applicability of the AQC 13
Design and Implementation Considerations 14
Appendix 16
References 17
3. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 3
ACKNOWLEDGEMENTS
Avalere would like to thank the individuals listed below for their insight and perspectives in
developing this report.
Katherine Baicker, PhD
C. Boyden Gray Professor of Health
Economics and Acting Chair, Department
of Health Policy and Management,
Harvard T.H. Chan School of Public Health
Robert Berenson, MD
Institute Fellow, The Urban Institute
Donald M. Berwick, MD
President Emeritus and Senior Fellow,
Institute for Healthcare Improvement
Michael E. Chernew, PhD
Leonard D. Schaeffer Professor of Health
Care Policy and Director of the Healthcare
Markets and Regulation Lab,
Harvard Medical School
Suzanne Delbanco, PhD
Executive Director, Catalyst for
Payment Reform
Dan Durham
Executive Vice President, Policy and
Regulatory Affairs, America’s Health
Insurance Plans
Elliott S. Fisher, MD, MPH
John E. Wennberg Distinguished Professor,
Geisel School of Medicine at Dartmouth
Director, The Dartmouth Institute for Health
Policy and Clinical Practice
Richard Gilfillan, MD
CEO, Trinity Health
Karen Ignani
President and CEO, America’s Health
Insurance Plans
Bob Kocher, MD
Partner, Venrock
Mark B. McClellan, MD, PhD
Senior Fellow and Director, Health Care
Innovation and Value Initiative,
The Brookings Institution
Robert Mechanic, MBA
Senior Fellow, Heller School of Social Policy
and Management at Brandeis University
Samuel Nussbaum, MD
Chief Medical Officer, Anthem, Inc.
Peter Orszag
Vice Chairman, Global Banking, Citigroup
Murray Ross, PhD
Director, Institute for Health Policy,
Kaiser Permanente
Dana Gelb Safran, ScD
Senior Vice President, Performance
Measurement and Improvement,
Blue Cross Blue Shield of Massachusetts
Andrew Webber
President and CEO, Maine Health
Management Coalition
Blue Cross Blue Shield of Massachusetts provided funding for this research. Avalere Health
maintained full editorial control and the conclusions expressed here are those of the authors.
4. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 4
EXECUTIVE SUMMARY
Rethinking how the U.S. healthcare system pays for care is critical to achieving better
outcomes at lower costs. As healthcare stakeholders explore new ways to achieve this
goal, existing payer models can provide valuable guidance. In particular, the Alternative
Quality Contract (AQC), launched by Blue Cross Blue Shield of Massachusetts (BCBSMA)
in 2009, seeks to drive quality, accountable, efficient care. Under the AQC, BCBSMA
holds providers accountable to a global, risk-adjusted budget, plus incentives for quality.
In turn, providers agree to a two-sided risk model that allows them to share not only in
savings, but also in the cost of care that exceeds targets.
The AQC has been studied more than other innovative payment models. In addition,
evaluations of the AQC span multiple years. To capture lessons learned from the AQC,
including lessons that could apply to other payers and markets, Avalere reviewed
existing literature and conducted interviews with key thought leaders, including
individuals with executive-level experience serving as part of key federal government
agencies, major health plans, and best-in-class providers. Based on our research,
Avalere identified the following observations that can inform future payment and
delivery innovations:
• Payment reform programs can significantly change provider behavior. Well-
designed models can curb medical spending and promote quality improvement
across a range of provider organizations.
• Changing behavior requires providers to have “skin in the game,” but payers
need to meet providers where they are today. A two-sided risk model, in which
providers can share in savings but must also repay deficits, grabs provider attention
and can help motivate significant change. Budgets based on historical spending
and meaningful incentives for hitting quality targets also encourage providers to
take on risk.
• New payment models should hold providers accountable for the full range
of patient care costs. Excluding certain types of services (such as prescription
drugs) dilutes the incentive to control spending and perpetuates uncoordinated,
inefficient care.
• Providers can implement meaningful change, but need time, consistent goals,
and a similar commitment from payers to do so. Providers need sufficient time
to experiment with different solutions and approaches. Longer-term spending
and quality targets also increase provider buy-in and demonstrate a clear
commitment from the payer.
5. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 5
• Providers need detailed spending and quality information and clinical support
to take on risk. Providers should take on greater financial risk for their patients’
care over time, but must be empowered by real-time access to data and care
redesign support.
• Payers with significant local presence are best positioned to implement
innovative payment models. Market share is critical in enabling payer investment
and focusing provider attention.
Payers and policymakers can transition toward rewarding quality and efficiency by
leveraging existing programs. Models like the AQC could serve as potential building blocks
for collaborations that align incentives across providers and several payers. Many aspects
of the AQC model, including provider engagement, availability of technical assistance,
and structured payment incentives, are relevant to other payers and markets. Indeed, the
AQC and other successful commercial ventures could serve as backbones for pilots that
engage the Medicare program and other government payers, with the potential to
transform healthcare delivery and spending.
6. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 6
ABOUT THE ALTERNATIVE QUALITY CONTRACT
The Alternative Quality Contract (AQC) seeks to reduce health system costs while
improving quality and health outcomes through a combination of payment incen-
tives and provider support tools. BCBSMA established an initial target of reducing
healthcare spending growth by 50 percent over five years, but found that providers
participating in the AQC can achieve this goal within four.
Core Elements
The AQC is built around several core elements, including: a global budget structure;
substantial performance incentives; a long-term contract between BCBSMA and
providers; and clinical and information support.
The AQC shares features with other population health management programs and
informed the development of the current Medicare Shared Savings Program (MSSP).i
Notably, however, the AQC offers a distinct risk and information-sharing structure from
MSSP. Additionally, the models differ in how budget targets and performance
benchmarks are set (see Appendix).
Program Participation
Participation in the AQC is voluntary but widespread. Currently, more than 85 percent of
primary care physicians (PCPs) and nearly 90 percent of specialists in BCBSMA’s closed
HMO network participate in the AQC. Collectively, they care for nearly 700,000 BCBSMA
Global Budget • Covers all medical expenses for the group’s patient population
• Set to curb spending growth relative to expected levels
• Level of risk varies by contract; most groups share savings and
losses with BCBSMA
Performance • Opportunity for significant incentives based on performance
against quality measures
• The better a group’s performance, the greater share of any
savings—and the smaller share of any losses—the group receives
Long-term Contract 3-5 year contract with fixed spending, quality targets
Information on Spending,
Quality; Regular Clinical
Support
Group-specific reporting and analysis, dedicated support team to
review performance and discuss improvement goals and strategies,
periodic educational and best-practice sharing forums
7. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 7
HMO members. Participation is also stable; provider groups who joined the AQC have
renewed the contract. BCBSMA is exploring how to expand the model to members
enrolled in open-network plans.
KEY OBSERVATIONS
Avalere consulted with 17 opinion leaders, including individuals with executive-level
experience at key federal government agencies, major health plans, and best-in-
class providers, to gain additional insight into BCBSMA’s experience with the AQC
and its national relevance. Based on these discussions and the existing literature,
Avalere identified six observations that should inform ongoing conversations about
payment reform.
Payment reform programs can significantly change provider behavior. The AQC has
been examined more extensively than other global budget models; researchers have now
examined up to four years of program outcomes.ii
These studies show that the program
has achieved its goals of improving quality while curbing spending growth. Specifically,
studies show that:
• AQC provider groups slow spending. AQC groups bring down spending
growth compared to providers outside the contract.iii, iv, v, vi
Initially, savings come
from changes in referral patterns (i.e., directing patients to lower-cost providers
for procedures and services), but providers gradually reduce use of services—
particularly advanced imaging, procedures, and tests—with no evidence that
reduced utilization compromises the quality of care.vii
The most recent evaluation
of the AQC found that AQC groups achieved a 10 percent savings on medical
spending by the fourth year.viii
8. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 8
Average Change in Spending per Enrollee, 2009 AQC Cohort vs. Control Group
ChangeinAdjustedQuarterlySpending
$12
$2
-$8
-$18
-$28
-$38
-$48
-$58
-$68
Evaluation and
Management
$3.42
Total
-$62.21
Procedures
-$17.62
Imaging
-$10.97
Durable
Medical
Equipment
-$1.57
Tests
-$7.83
Other
-$5.54
Source: Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The
New England Journal of Medicine, 371(18)2014; 1704-14. Pecentages based on average post-intervention claims in the AQC cohort.
• AQC provider groups improve quality of care. AQC provider groups have
demonstrated immediate (year 1) and sustained improvements in quality, though
improvement is not uniform across all measures.ix, x, xi
Substantial improvements
on measures like blood pressure and cholesterol control are likely saving lives.
Interestingly, provider performance does not tend to improve on measures not
tied to payment, demonstrating the importance of incentives.xii
9. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 9
• The AQC is effective for a range of provider types and patient populations.
AQC participants showed cost savings and quality improvement across provider
groups of varying size, level of integration, previous experience with risk, and patient
population characteristics, including patients of varying socioeconomic status.xiii
• AQC provider groups positively impact patients outside of the contract.
Although the AQC only covers BCBSMA’s commercial enrollees, research shows
that AQC groups change some of their care management practices broadly
across their patients, leading to cost savings for other populations (e.g., Medicare
beneficiaries). This spillover effect is larger on spending than on quality.xiv, xv
Changing behavior requires providers to have “skin in the game,” but payers need
to meet providers where they are today. Most thought leaders agreed that a two-
sided risk model—in which providers can share in savings, but must also repay deficits—
is necessary to grab provider attention and motivate changes in behavior, particularly
referral and practice patterns. Not all providers are ready to take on risk, and payers
Average Performance on Outcome Measures, 2009 AQC Cohort vs. Control Group
PercentofPopulationMeetingTarget
90
80
70
60
50
40
30
20
10
0
80.6
84.1
57.7
65.2
51.6
65.4
69.9
74.8
68.4
80.4
Diabetic HbA1c
Control
Diabetic LDL
Cholesterol
Control
Diabetic Blood
Pressure
Control
LDL Cholesterol
Control in
Patients
with CAD
Blood Pressure
Control in
Patients with
Hypertension
Source: Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The
New England Journal of Medicine, 371(18)2014; 1704-14. CAD = coronary artery disease
2009 2012 2012 National Average
10. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 10
have an important role to play in positioning providers for success. Regardless, aligning
incentives and integrating providers fully into the discussion about how to drive value
should be the goal. As one expert said:
“You get more savings, more quality improvement, and more practice transformation
at higher levels of risk.”
Experts also agreed that payers trying to implement two-sided risk need to “meet
providers where they are” and noted that budgets based on historical spending make
risk-based contracts more appealing to providers. However, historically based spending
targets can “bake in” inefficiency in provider spending and/or payment rates, making
them more attractive to less efficient providers and less attractive to providers who are
already controlling costs. Therefore, several experts suggested that payers try to move
from budgets based on historical spending to a standard based on average performance
or another fixed target. Along these lines, the AQC now requires providers to “beat trend”
in terms of their spending growth—that is, providers must outperform other network
groups, many of whom are also participating in the AQC. Interviewees also suggested
that payers explore options to reduce the total cost of care (i.e., achieving an absolute
reduction in real, inflation-adjusted spending) versus spending growth.
Payers and providers need to take into account unexpected costs and events. In a risk-
based contract, adjusting the budget to guard against these costs is critical, particularly
for smaller groups, to ensure that providers are not penalized for treating higher-need
individuals. AQC budgets are adjusted for patient risk, and providers groups are also
required to have stop-loss or reinsurance coverage.
In addition to using historical spending to establish budgets, the AQC allows providers
to earn substantial payments based on quality. Several thought leaders emphasized the
importance of quality payments and noted that no provider should “make money in
the context of a quality decrease.” The size of the AQC quality incentives is likely very
appealing to providers, though it has decreased over time. Performance incentives in
the AQC are paid on a monthly basis and reconciled at the end of the year, allowing
providers to use these funds sooner. In addition to providing a strong financial incentive,
the AQC’s emphasis on quality helped physician leaders motivate their colleagues to
join the program. Quality-based payments to AQC groups outstripped savings in the
first years of the program and resulted in higher total outlays for BCBSMA, but savings
made up for quality incentives by the fourth year. Other payers could find it challenging to
fund up-front payments based on quality while they wait for savings, and might need to
explore non-traditional opportunities (e.g., participating in a federally or state-funded pilot
program) to support a similar approach.
11. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 11
The AQC’s budget approach and quality incentive payments likely contributed to its
high rate of provider participation. However, experts believed that similar models should
transition providers to greater risk over time. BCBSMA offers providers a range of risk
options, with most AQC groups now at risk for 50 to 80 percent of savings or losses
(AQC groups that assume less than 100 percent risk share both savings and deficits with
BCBSMA). BCBSMA encourages providers to bear more risk over time, but allows the
shift to be provider-led. Other payers could take a more active approach, such as by
funneling patients to groups that are willing to accept greater risk.
New payment models should hold providers accountable for the full range of
patient care costs. Experts also agreed that providers should be accountable for all
patient costs, and that excluding certain types of services (such as prescription drugs)
could dilute the incentive to control spending. Indeed, one thought leader shared:
“The more you include [in the budget] the more the incentive for the provider to really
think holistically about the patient’s care…so that it’s high-quality and affordable.”
Importantly, holding providers accountable for all patient care costs is easier in markets
where the healthcare system is organized—that is, where primary care providers and
specialists have strong relationships with hospitals, ancillary service providers, and others.
In addition, payers that have visibility into all patient claims will be better equipped to pay
providers through a global budget. In the Medicare program and in some state Medicaid
programs, for example, prescription drugs are treated and paid for differently than medical
services, making it more difficult—but not impossible—to integrate these benefits into a
single budget.
Providers can implement meaningful change, but need time, consistent goals, and
a similar commitment from payers to do so. Providers need time to experiment with
potential solutions, and to realize the benefits of interventions that require substantial
up-front investment. For example, integrating behavioral health services can produce
more coordinated, higher-quality care.xvi
Many AQC groups have hired social workers or
behavioral health specialists who focus on coordinating care for patients who need these
services. Integrating an entire category of benefits and services is a substantial undertaking,
and providers must have adequate time to make adjustments without immediate
financial consequences.
Aligning provider incentives with longer-term spending and quality targets is also likely
to increase provider buy-in. Unlike other models in which spending or quality targets are
reassessed each year, AQC contracts contain fixed spending and performance goals.
These targets do not change based on provider performance or other factors. Several
experts favored this approach, while others preferred an option to readjust (for example,
12. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 12
if participating providers achieved substantial savings in the initial years, or market
dynamics shifted). One interviewee commented:
“[A] substantial, guaranteed contract makes sense when investment is required to
change models of care delivery.”
Finally, a longer-term arrangement demonstrates a clear commitment from the payer.
Experts noted that aligning incentives through the AQC improved payer-provider
communication, because it made providers—particularly smaller groups—and BCBSMA
more reliant on each other.
Providers need detailed spending and quality information and clinical support to
take on risk. Experts agreed that providers must be positioned for success via access
to data and clinical support. Data timeliness and usability are critical. Larger provider
groups may have—or be better positioned to purchase—software and tools to analyze,
monitor, and act on patient data. Smaller groups, however, will likely look to payers to
provide analytic resources.
The payer’s role should not be limited to delivering information. Payers must also
participate in care redesign. Each AQC group has a dedicated BCBSMA team that provides
analytic and clinical support. The teams work across multiple provider groups, and often
relay lessons learned and strategies from one group to another. BCBSMA also convenes
multi-group sessions where providers can interact. Overall, one expert emphasized:
“Providers need more than a claims dump—they need the plan to package and
synthesize the information so that they can act on it.”
Payers with significant local presence are best positioned to implement innovative
payment models. Experts agreed that unless a payer covers a significant portion of a
provider group’s patients, competing payer initiatives make it hard for providers to focus
on specific cost and quality priorities. Commercial plans will need significant market
share to make innovative payment models work. Local market presence also means that
payers are familiar with each provider group’s capabilities. BCBSMA is able to adjust
its approach based on the group’s risk-readiness, experience, patient population, and
ProviderPayer
Information sharing, clinical support, spending
and quality data reporting
13. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 13
other factors. Adopting a group-specific approach could be challenging in a larger-scale
(i.e., national) program, but allows BCBSMA to balance provider interest with program
financial goals.
CONSIDERATIONS FOR FUTURE INITIATIVES
Applicability of the AQC
Multiple peer-reviewed studies show that the AQC can reduce spending growth while
improving quality of care. Avalere’s interviews revealed that experts are interested in
ongoing evaluation of the AQC to ensure that these results are sustainable in the long
term, but found the program’s outcomes to date compelling for the national discussion
on payment reform. As one expert noted:
“My view is that the AQC is extremely promising as a guide to payment reform in
other settings.”
In order for a payment model to be broadly applicable, other payers in different markets
must be able to expect the same or similar results. Massachusetts, where the AQC
operates, is a unique healthcare market in many ways given its historically high spending
and the presence of several large, nationally recognized health systems, provider groups,
and health plans. Further, the state’s healthcare reforms acutely focused most healthcare
stakeholders on containing costs, likely encouraging providers to experiment with
new payment and delivery models. Experts interviewed for this paper agreed that the
Massachusetts environment was important, but not necessary, in enabling the AQC’s
success. Indeed, one interviewee shared:
“It’s worked in a heterogeneous world of providers in Massachusetts, from small
provider groups to large health systems, and for all types of practices to generate
savings shows that it’s a flexible and adaptive and effective payment methodology.”
Finally, the AQC has been implemented for patients enrolled in HMO products, where
the patient is required to identify a PCP. BCBSMA is exploring how to transition the
model to its Preferred Provider Organization (PPO) products. PPOs are more common
nationwide but do not require the enrollee to select a PCP, making attribution less
straightforward. The Medicare program has confronted the same challenge in the
Pioneer and MSSP programs, since beneficiaries in traditional Medicare do not have
14. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 14
a named PCP. Instead of relying on patient selection, BCBSMA will—like CMS—use
claims data to define patient populations and attribute them to AQC groups. Testing
to date with patients and providers suggests that this approach produces accurate
results.
Design and Implementation Considerations
New payment programs like the AQC are gaining traction, but in most places fee-
for-service payment remains the dominant system. As discussed above, the market
presence of the payer is a critical success factor for payment reform. Combining
the enrollment of several payers in a multi-payer pilot—with the potential for smaller
payers to participate—could capitalize on the opportunity these innovative models
present. The Affordable Care Act may provide a path forward for public-private
partnerships by charging the Secretary of Health and Human Services with testing
innovative payment models, including models that rely on “risk-based comprehensive
payment.”xvii
A multi-payer collaboration that follows the model of the AQC would need to address
a number of design and implementation issues, including:
• Synchronizing how patients are assigned to provider groups. Patient assign-
ment based on “real time” provider affiliation is an important feature of the AQC.
Knowing who is covered by the contract allows providers to focus their efforts
and makes tracking and adjusting performance more predictable. In addition, this
approach captures new patients without holding providers accountable for those
who have left the practice.
• Aligning quality measures, data collection, and analytics across payers.
Providers in a multi-payer pilot would likely need to report against a single,
consolidated set of quality metrics to maximize quality improvement. Experts
consistently agreed that providers should report on fewer, more meaningful quality
measures. One expert encompassed this thinking, saying:
“In general, simpler is better. Fewer metrics, and clearer definitions,
and standardization across payers.”
• Allowing group-specific variation in goals and expectations. Groups
participating in the AQC can take on different levels of risk. Public payers like
Medicare would likely need to adopt a consistent approach across providers;
for example, with respect to how much risk providers assume. Adopting a uniform
approach across all provider groups could make it challenging to maximize the
financial benefits of the model, because the average level of risk will necessarily
be lower than what some groups can achieve.
15. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 15
• Providing on-the-ground support. Payers with strong local market presence
can use their existing relationships with provider groups to gain buy-in and support
ongoing improvement. Achieving a similar level of visibility and engagement at the
group level could be difficult—but not impossible—for public programs.
• Engaging the patient through value-based insurance design. As a private
payer, BCBSMA can engage patients through benefit and network design in a
way that would require creative policy solutions in public programs. For example,
BCBSMA can modify patient cost sharing so that patients are encouraged to use
lower-cost services, complimenting provider efforts.
The federal government has made a substantial investment in new payment models via
ACOs across the country. If a multi-payer pilot in Massachusetts with the AQC as its
backbone could be successful, policymakers would have an intriguing and unique option
to test risk-based contracting models.
Payment reform
models can
significantly
change provider
behavior.
Providers can
implement meaningful
change, but need
time, consistent
goals, and partnership
from payers.
Providers should
have “skin in the
game,” but payers
need to meet
providers where
they are.
Successfully
managing risk
requires information
and clinical support.
Providers should be
accountable for all
healthcare costs.
Payers with
significant local
presence are best
positioned to
implement innovative
payment models.
16. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 16
APPENDIX
Comparison of AQC, MSSP Models
ALTERNATIVE QUALITY
CONTRACT
MEDICARE SHARED
SAVINGS PROGRAM
Risk Structure 2-sided (savings and losses) 1-sided (savings only); must transition
to 2-sided over time
Budget Scope All services All services except outpatient
prescription drugs.
Budget Origin Each AQC group’s historical
spending; adjusted for risk. Each
year’s spending growth target tied
to regional trend.
Based on spending for patients who
would have been assigned to ACO in
prior years; adjusted for risk.
Quality Measure Set 64 process, outcome, and experience
measures; hospital and ambulatory
care measures included.
33 measures related to patient and
caregiver experience, care coordination
and patient safety, preventive health,
and at-risk populations.
Quality Incentives Separate payments for quality based
on set of 5 performance thresholds;
paid monthly and reconciled at year-
end. Annual thresholds fixed during
contract period.
Providers must achieve annual quality
targets based on national data. Share
of savings depends on overall quality
performance. No separate payments
for quality.
Patient Assignment Updated monthly based on patient’s
active PCP selection.
Currently retrospective, based on
beneficiary’s use of primary care services.
17. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 17
REFERENCES
i According to several interviewees familiar with the development of MSSP.
ii Based on a structured literature review conducted by Avalere Health. Avalere Health searched for studies examining the impact
of global budgets on spending and/or
iii Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The New
England Journal of Medicine, 371(18) 2014: 1704 – 14.
iv Song, Z., Safran, D. G., Landon, B. E., et al. “The Alternative Quality Contract, Based On A Global Budget, Lowered Medical
Spending and Improved Quality,” Health Affairs 31(8) 2012: 1–10.
v Song, Z., Safran, D. G., Landon, B. E., et al. “Health Care Spending and Quality in Year One of the Alternative Quality Contract,”
The New England Journal of Medicine, published online July 13, 2011.
vi Two studies showed no significant change in pediatric or prescription drug spending, respectively. See Chien, A.T., Song, Z.,
Chernew, M., et al. “Two-year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending.”Pediatrics,
133(1), 2014: 96-104 and Afendulis, C., Fendrick, A.M., Song, Z., et al. “The Impact of Global Budgets on Pharmaceutical
Spending and Utilization: Early Experience from the Alternative Quality Contract.” INQUIRY, January – December 2014 (51), first
published January 1, 2014
vii Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The New
England Journal of Medicine, 371(18) 2014: 1704 – 14.
viii Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The New
England Journal of Medicine, 371(18) 2014: 1704 – 14.
ix Song, Z., Rose, S., Safran, D. G., et al. “Changes in Health Care Spending and Quality 4 Years into Global Payment,” The New
England Journal of Medicine, 371(18) 2014: 1704 – 14.
x Song, Z., Safran, D. G., Landon, B. E., et al. “The Alternative Quality Contract, Based On A Global Budget, Lowered Medical
Spending and Improved Quality,” Health Affairs 31(8) 2012: 1–10.
xi Song, Z., Safran, D. G., Landon, B. E., et al. “Health Care Spending and Quality in Year One of the Alternative Quality Contract,”
The New England Journal of Medicine, published online July 13, 2011.
xii Chien, A.T., Song, Z., Chernew, M., et al. “Two-year Impact of the Alternative Quality Contract on Pediatric Health Care Quality
and Spending.” Pediatrics, 133(1), 2014: 96-104.
xiii Lewin, J. “The Impact of the Massachusetts BCBS Alternative Quality Contract on Lower Socioeconomic Status Populations,”
Lewin and Associates – Health Innovation Strategies, LLC, 2013.
xiv McWilliams, J., Landon, B., Chernew, M. “Changes in Health Care Spending and Quality for Medicare Beneficiaries Associated
With a Commercial ACO Contract,” The Journal of the American Medical Association 310(8) 2013: 829-836.
xv Other studies examining spillover effects on Medicare FFS populations from increasing managed care (i.e. HMO) penetration
suggest that cost savings in total Medicare FFS spending range from one to nine percent. Source: Chernew, Michael, Baicker,
Katherine, and Martin, Carina. “Spillovers in Health Care Markets: Implications for Current Law Projections.” Last Accessed
December 30, 2014. Study available here: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/ReportsTrustFunds/downloads/spillovereffects.pdf
xvi National Quality Strategy: 2014 Annual Progress Report to Congress. Principle 8. Available at: http://www.ahrq.gov/workingfor-
quality/nqs/principles.htm.
xvii Affordable Care Act, Section 3021(b)(2)(B)(ii)
18. Payment Reform on the Ground: Lessons from the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 1
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