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Home / News & IndustryManaged Care Insight and Analysis
Updated: June 15, 2010
Massachusetts Health Plan Developing ‘Critical Mass’ To Make Dent In Quality, Cost

By collaborating with some of Massachusetts’ 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 healthcare.

"Having a deep well of primary care physicians makes it 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 include:

  • 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 patients; and
  • Caritas Christi Health Care in Boston, the largest 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 the 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 on the 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 patient 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 hospital 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 HCPA.

With the addition of Caritas Christi, 20 percent of BCBSMA’s provider network is now in the AQC – providing care for more than a quarter of BCBSMA’s Massachusetts-based HMO members.

Address: Blue Cross and Blue Shield of Massachusetts, Landmark Center, 401 Park Drive, Boston, MA 02215-3326; (800) 262-2583, www.bluecrossma.com.


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

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