Blues’ Quality Contract Raising Hackles in Massachusetts: Medpage Today

Summary: There’s a huge debate in this country about value-based medicine. Instead of paying for any old procedure, the argument goes, we should be paying for performance: for procedures and practices that generate success in health, in preventive medicine and generally better care. But it’s hard to define what “better” means in many cases. The details are confusing, and the workings of such programs seem abstruse to many. So this is a breath of fresh air: Here’s an abstract of a recent piece from our partner MedPage Today explaining the issues clearly, both pro and con.

 

 


This piece is about a debate about one such program in Massachusetts, written by Brant S. Mittler, MD, JD, who has been a cardiologist in private practice in San Antonio for the past 38 years and has an active litigation practice in healthcare law. Read the entire piece for a clear explanation of the issues.

“Just as RomneyCare begat Obamacare, Blue Cross Blue Shield of Massachusetts says its global payment plan for HMO patients — called the Alternative Quality Contract (AQC) — is destined for wider acceptance nationally.

“First introduced in 2009, the health plan’s AQC now covers 680,000 of the plan’s HMO members via risk-adjusted global payments that cover all outpatient, inpatient, and pharmacy services. It’s an ‘alternative’ payment method to fee-for-service payments.

“There are payment incentives in the contract for medical groups to earn up to 10% more of their global budget in bonuses by meeting 64 pre-defined quality metrics from the Healthcare Effectiveness Data and Information Set (HEDIS) — half inpatient measures and half outpatient measures. The health plan believes using the metrics can bend the healthcare cost curve while enhancing the quality of care…

“Several Massachusetts physicians who practice under the AQC — many of whom run residency training programs — said in exclusive interviews with MedPage Today that there is a dark side to the health plan’s quality metrics, which foster gaming the system, cause staff to ‘teach to the test, and need to be updated with better evidence-based practices.

“‘There are too many metrics, too confusing and too misaligned … The AQC metrics have nothing to do with health and they don’t reduce costs,’ said Stephen Martin, MD, professor of family medicine at the University of Massachusetts Medical Center in Worcester.” Brant S. Mittler, via Blues’ Quality Contract Raising Hackles in Massachusetts, Medpage Today.