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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 10, 2009
BCBSMA Signs First Groups To Alternative Quality Contract

Blue Cross Blue Shield of Massachusetts (BCBSMA) has signed its first provider groups – Mount Auburn Hospital (MAH) and the affiliated Mount Auburn Cambridge Independent Practice Association (MACIPA), and Hampden County Physician Associates, LLC (HCPA) – to its new five-year Alternative Quality Contract (AQC).

First offered in 2008, the AQC pays doctors and hospitals based on the quality and outcome of the care they provide to patients. The AQC is designed to improve the quality of care our members receive and cut current annual medical cost trends in half, BCBSMA said.

"The announcement reflects the shared vision by BCBSMA and our physician partners at MACIPA and HCPA of a healthcare system that delivers safe, effective and affordable care," said Cleve Killingsworth, BCBSMA’s chairman and CEO. "BCBSMA believes the most promising way to moderate the increase in the cost of care is to improve quality. The most effective way to do that is to pay doctors and hospitals for the quality and outcome of their care."

Also included was BCBSMA’s separate agreement with 45 doctors in Western Massachusetts who are part of HCPA.

The AQC is a significant change from traditional fee-for-service contracts. It combines two forms of payment. The first is a global, or fixed, payment per patient adjusted for age, sex, and health status which 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, BCBSMA said.

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.

Employers benefit as the new system moderates cost increases through better care.

Address: Blue Cross Blue Shield of Massachusetts, 401 Park Dr., Boston, MA 02115; (617) 246-5000,

  This article was taken from:
Pay-For-Performance Reporter

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