HIMSS webinar: Blue Cross outlines success with incentivizing ACOs
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Presented during this week’s "Healthcare Information & Management Systems Society (HIMSS) Virtual Forum, Achieving Quality and Efficiencies in Health IT: Perspectives from Accountable Care Organizations (ACOs),” Safran outlined the incentive model and shared some lessons and early outcomes in the model.
In 2007, leaders at BCBSMA challenged the company to develop a new contract model that would improve quality and outcomes while significantly slowing the rate of growth in healthcare spending. “Massachusetts’ individual mandate in 2006 caused a bright light to shine on the issue of unrelenting double-digit increases in healthcare spending growth,” stated Safran who cited data that BCBSMA Medical Trend went from 8.2 percent in 2000 to 12.8 in 2009. BCBSMA believed the key to slowing healthcare costs was to incentivize the delivery system to improve the quality, safety and effectiveness of care. Based on this belief, they developed and implemented the AQC.
Safran noted there were five key components of the the AQC model:
- Accountability for quality and resource use across the full care continuum;
- Long term contract of five years;
- A per-patient global budget;
- An annual inflation tied to the consumer price index; and
- Significant set of incentives based on a set of core quality measures.
There are 64 quality measures in total spanning across ambulatory care and hospital care settings. In both of those settings, the quality measures included clinical process, clinical outcome, patient care experience and developmental measures. Included in these measures are the outcomes of critical condition controls, including diabetes, cardiovascular disease and hypertension in ambulatory side and postoperative complications, hospital-acquired infections, obstetrical injury and mortality on the hospital side.
Safran noted that the measures are drawn from nationally-accepted measures. “We are not in the business of developing our own quality measures,” she noted in the question and answer portion of the presentation, titled “Rewarding Good Behavior: The Impact of Incentives on Driving the ACO Paradigm Shift.”
Since the beginning to the program, the AQC has seen significant growth from January of 2009 (26 percent of BCBSMA network linking into the model [305,000]) to 2011 (44 percent [470,000]). Safran mentioned she believes one of the factors contributing to such a large interest in the model is the knowledge that there’s a strong understanding that collectively, the industry is moving away from a fee-for-service model.
Safran reiterated that early results are favorable. Every AQC organization showed improvement on the clinical quality measures, including several dozen clinical process and outcomes measures, she noted. “For important preventive care measures, like cancer screening and well-child visits, as well as chronic disease care measures, AQC groups’ performances were three times that of non-AQC groups and more than double the AQC groups’ own improvement rates before joining the AQC,” her presentation noted, adding that AQC groups exhibited exceptionally high performance for all clinical outcome measures with more than half approaching or meeting the maximum performance target on measures of diabetes and cardiovascular care.
Financially, AQC is on track to achieve the goal of reducing cost trends by 50 percent over five years. According to Safran, all AQC groups reported budget surpluses, which afforded them the opportunity to make infrastructure investments. She additionally cited that longitudinal evaluation found that, relative to traditional fee-for-service contracts, the AQC cohort reduced medical spending by 2 percent in the first year.
“Groups have started reducing non-urgent emergency room visits – one group by 22 percent – by promoting urgent care center or offering after-hours appointments, and by identifying additional support for patients with unusually higher ER use,” she said.
Additionally, AQC groups are reducing hospital readmissions – one group by 15 percent – by increasing contact and integration between patient and physician offices after hospitalization, and in some cases, making home visits for patients particularly vulnerable to re-admission.
Presently, the AQC is a provider contract and not a product, Safran stated. However, she did not rule out the possibility that a product could be developed in the future for a select network.
Going forward, BCBSMA will continue to develop, expand and refine the AQC mode. “At its core, it’s a mode that’s rooted in primary care,” Safran concluded.