- Blue Cross Blue Shield of Massachusetts' Alternative Quality Contract (AQC) population health program with two-sided risk cut per-enrollee spending by as much as 11.9% compared to a control group, according to a recent study published in the New England Journal of Medicine.
- Researchers from Harvard and Tufts University medical schools, Massachusetts General Hospital and Haven Boston studied eight years of AQC data.
- Along with the cost savings, the percentage of members in the AQC who received quality care for chronic disease management also rose.
There has been much debate about whether alternative payment models such as accountable care organizations (ACOs) can effectively manage patient care while cutting costs, as the results have often been quite modest. That has prompted CMS to require providers participating in the various ACO initiatives to accept downside risks sooner than in the past.
The New England Journal of Medicine study suggests that there may be something to providers accepting more risk in terms of improving care and cutting costs. Researchers examined eight years of data (2009-16) from the Massachusetts' Blues' ACQ program and compared it to a control group of more than 1 million patients enrolled in commercial health plans in eight northeastern states.
Patients who enrolled in the AQC in 2009 saw increases in medical spending by 2016 that were $461 lower than those in the control group, an 11.7% relative savings in claims; $471 lower among those who enrolled in 2010, an 11.9% savings; and $312 lower among those who enrolled in 2011, a 6.9% relative savings.
According to the study, the initial savings for those enrolled in the AQC came through referrals to lower-priced providers. In later years, the savings "were generated increasingly through lower utilization, including the use of laboratory testing, certain imaging tests, and emergency department visits."
However, quality of care improved for those enrolled in the AQC. For example, 81% of those with diabetes received what is considered high-quality disease management prior to enrolling in the AQC. That rose to 88% after they entered the model. There were also increases in the quality of care for adult preventative care, pediatric care and outcomes for blood sugar and blood pressure control.
There were also some caveats to the study. Its authors noted that 71% of the relative decrease in spending was attributable to lower provision of services. In other words, those enrolled in the AQC were receiving less care compared to the control group. However, a smaller percentage of enrollees left the AQC during the study period than those in the control group health plans, suggesting that the former provided a higher level of consumer satisfaction.
The study did note that the voluntary nature of participating in the AQC may have led to some selection bias, although that tended to be canceled out by the fact that providers faced penalties for not participating. "These findings suggest that an ACO model with both financial rewards and penalties ... may offer a framework for slowing the growth in medical spending without sacrificing the quality of care for patients," the study concluded.