Blue Cross Blue Shield of Massachusetts slows spending growth with global budget: study 

hospital money
A new study dives into a value-based model operated by Blue Cross Blue Shield of Massachusetts. (Getty/PraewBlackWhile)

A global budget model launched by Blue Cross Blue Shield of Massachusetts slowed healthcare spending growth by 12% over eight years, according to a new study. 

Blue Cross created the Alternative Quality Contract (AQC) in 2009, and researchers at Harvard Medical School studied claims data through 2016 to weigh the effectiveness of the model. Average annual claims for doctors in AQC were, on average, $461 less than physicians who were not enrolled in the program. 

In addition, over the eight-year study window, the researchers found improvements in care quality compared to regional and national benchmarks, particularly in chronic care management. 

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Matt Day, senior vice president for network payment innovation and contract management at Blue Cross, told FierceHealthcare that one of the model’s unique features is that it has been under consistent objective study since its inception, which lends credence to its benefits when providers are weighing enrollment. 

“We been very open and public with our model and the things that work with the hope of having it spread across the country,” he said. 

The study found that savings early on were below incentive payments made to providers. But around the fourth year of the model, it began to generate net savings that exceeded such payments. 

AQC was also associated with quality improvements beginning as early as the first year for some providers, the researchers found. 

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The key to these metrics? Day said it was crucial for Blue Cross to build the model with input from providers and to continue to include them in the process as it evolved.  

For example, providers were central to recent moves to include additional patient-reported outcome measures, such as how they’re performing activities of daily living, and assisted heavily in identifying clinical quality measures. 

Provider input from the beginning was also necessary for buy-in on two-sided risk, Day said. 

“It’s the close relationships that we have with the systems here that have allowed us to challenge them to improve and reward them for improving,” he said. 

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