Alternative quality care contracts can be 'backbone' for payment reform

The alternative quality care (AQC) contract that Blue Cross Blue Shield of Massachusetts has had in place since 2009 could serve as a payment reform "backbone" for other insurers as they increasingly reward quality, efficient care, according to a new report from Avalere Health.

After reviewing existing literature on AQC contracts--which rewards providers financially if they reach certain quality targets and lower costs--and conducting interviews with key opinion leaders, Avalere recommended that Medicare and private insurers consider implementing the payment method. Given Medicare's decision to set clear goals and establish a timeline in shifting to more value-based payments, as FierceHealthFinance previously reported, AQCs could help the government insurer curb spending and improve quality.

"The Administration has set aggressive goals for quality based payments and integration in Medicare and other government programs," Avalere CEO Dan Mendelson said in a statement. "Using proven models such as the AQC in important markets will be necessary to move the delivery system along at this pace."

That's because researchers have examined the AQC model for up to four years, finding it does improve quality while lowering spending. In particular, Avalere said the studies have found the following:

  • AQC provider groups have slowed spending by almost 7 percent, largely because they gradually reduce patients' use of services, especially advanced imaging, procedures and tests;
  • AQC provider groups have improved quality care, with particular improvements on blood pressure and cholesterol levels;
  • the AQC model is effective for different provider types and patient populations; and
  • AQC provider groups impact patients outside of the contract, as doctors change many of their care management practices across all their patients.

To learn more:
- here's the Avalere statement and report