Blue Cross Blue Shield of Massachusetts (BCBSMA) inked a contract with Tufts Medicine that rewards the provider organization for reaching certain goals in a value-based payment structure that includes equity benchmarks.
The program—which the Blues plan calls one of the first in the nation—pays provider organizations for meeting those goals, Mark Friedberg, M.D., BCBSMA’s senior vice president of performance measurement and improvement, told Fierce Healthcare.
BCBSMA will pay Tufts Medicine for reducing inequities in care for colorectal cancer screenings, diabetes care, hypertension and child and adolescent well-care visits. Tufts Medicine joins Steward Healthcare Network, Beth Israel Lahey Health, Mass General Brigham and Boston Accountable Care Organization, which is part of Boston Medical Center. Those organizations signed their contracts with BCBSMA last December. Fifty-three percent of BCBSMA members in the state now have access to physicians who belong to the equity project. The contracts for all the plans began Jan. 1, 2023, with Tuft Medicine’s contract retroactive to that date.
“It’s new,” Friedberg said. “To my knowledge, nobody else is doing this currently. But I think there will be some other payers in the coming years—hopefully soon—who will be doing something very similar.”
Michael Dandorph, CEO of Tufts Medicine, said the move represents the latest effort on that organization’s part to make healthcare more affordable, accessible and equitable. “For more than a decade, we have aligned quality incentives within our contracts,” Dandorph said in a press release. “Equity is one of our key quality metrics, so including this in our relationship with Blue Cross is a natural progression and will ensure continued superior outcomes for our patients.”
The equity benchmarks, contained in an Alternative Quality Contract, are included in the general contract that the insurer and provider organizations hammer out, usually every three years.
“There’s a bonus structure that’s associated with the Alternative Quality Contract,” Friedberg said. “It is very similar to Accountable Care Organization contracts where it has an upside and a downside risk share between the payer and the provider. Bonuses are paid out after the annual period of performance. So, even though contracts in general are three years in length, they settle up every single year. And that bonus amount will be higher if the inequities at baseline are partially eliminated than if they weren’t eliminated at all. And they’ll be paid even more if the inequities are eliminated entirely. That’s the maximum payout on pay for equity.”
The not-for-profit Tufts Medicine encompasses Tufts Medical Center, Tufts Medical Center Physicians Organization and Tufts Medicine Integrated Network, comprising 2,300 primary care and specialist physicians and advanced practice clinicians.
BCBSMA says it gathers and publishes data each year for more than 1.2 million commercial Massachusetts members, and those data reveal where racial and ethnic inequities in care exist. Those data lay the foundation for the plan’s equity effort, executives said.
“We do a lot of consultation and shared learnings in partnership with the Institute for Healthcare Improvement to help provider organizations generate at least a working idea about the root causes for the racial and ethnic inequities that we see for our members that they serve,” Friedberg said.
The press release stated that “as part of that work, Blue Cross funded $25 million in Institute for Healthcare Improvement grants to support physician practices and hospitals with Alternative Quality Contracts in their efforts to eliminate racial and ethnic inequities in care and share learning across institutions.”
Not every provider organization can obtain an Alternative Quality Contract, said Friedberg.
“To be eligible for pay for equity, as an Alternative Quality Contract group, we have to have the ability to measure an existing baseline inequity with enough statistical precision that we can then measure also a reduction in the inequity over time,” he said. “And so, the most common reason a group would not be eligible for pay for equity would be the group just isn’t big enough, meaning it just doesn’t have enough total members.”
Even physician groups large enough to participate might be turned away because the population they serve isn’t diverse enough.
Friedberg hastens to add that the majority of physician groups in Massachusetts can participate and that BCBSMA wants to sign up all eligible groups in the state to start participating in January 2024.
“We have an approach that we think is a really good one for our market,” Friedberg said. “And we started by working with stakeholders outside the company, with experts within the company, and also by gathering input from all the provider organizations there in the Alternative Quality Contract about a year before we had any groups fully signed up for pay for equity. And that was really important to getting buy-in so that they feel comfortable signing up for it because we took their input seriously and incorporated a bunch of their ideas.”