Health Plan Developing ‘Critical Mass’ To Make Dent
In Quality, Cost
By collaborating with some of
largest hospitals and physician group practices, Blue Cross Blue Shield
of Massachusetts (BCBSMA) is creating a critical mass of patients and
providers to strike deep into the heart of cost and quality of
"Having a deep well of primary care physicians
easier to manage patients’ care and succeed in a risk-based
contract," said Jeanette Clough, president and CEO of Cambridge,
Mass.-based Mount Auburn Hospital, a 210-bed Harvard teaching hospital.
BCBSMA cover nearly three million people.
Mount Auburn is one of several provider groups
contractually bound to the BCBSMA Alternative Quality Contract (AQC) to
get a handle on quality and care. Some of the other provider groups
- Mount Auburn Cambridge Independent Practice
Association (MACIPA). It has more than 300 primary care and specialty
physicians with staff privileges at Mount Auburn;
- Hampden County Physician Associates (HCPA), a
multispecialty practice in western Massachusetts, treating 5,000
- Caritas Christi Health Care in Boston, the
community-based hospital network in New England with six hospitals,
approximately 1,100 physicians, treating close to 60,000 BCBSMA members.
Other partners include Tufts Medical Center and
affiliated New England Quality Care Alliance; Signature Healthcare
Corp., 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; and Atrius Health.
"The momentum of the AQC demonstrates that we are
right track to improving the quality of care and slowing the growth of
costs in Massachusetts," said Cleve Killingsworth, CEO of BCBSMA.
AQC pays two different ways: a fixed payment per
that is age, sex and health status adjusted; and by incentives for
meeting performance criteria tied to the latest nationally accepted
measures of quality, effectiveness and patient experience of care.
The AQC aligns the financial interests of the
and physicians, encouraging them to work together to provide
high-quality, efficient care – and reap financial rewards for
doing so. Either payment method is designed to improve the quality and
affordability of healthcare.
"I’ve been waiting for global capitation
to come back around for 20 years now," said Robert Suchecki, CEO of
With the addition of Caritas Christi, 20 percent
BCBSMA’s provider network is now in the AQC –
care for more than a quarter of BCBSMA’s Massachusetts-based
Address: Blue Cross and Blue Shield of
Massachusetts, Landmark Center, 401 Park Drive, Boston, MA 02215-3326;
(800) 262-2583, www.bluecrossma.com.