Study finds savings, care improvements in Blue Cross global budget model


A global budget reimbursement model improved the quality of patient care and lowered costs in its first four years, according to a study published in The New England Journal of Medicine.

Researchers from Harvard Medical School's Department of Health Care Policy analyzed claims data for the Blue Cross Blue Shield Alternative Quality Contract (AQC), which provides a budget for providing care. They concluded it provides a viable alternative to the fee-for-service model, according to an announcement.

They looked at financial and quality results for patients whose doctor took part in an AQC contract, comparing them to a control group of commercially insured patients.

The model slowed medical spending on claims by 6.8 percent over the four years under the AQC.

Outpatient services accounted for most of the savings with fewer procedures, imaging and tests performed, some of which were overused in the first place, the researchers said.

The study also found improved blood pressure and cholesterol control, and a higher percentage of diabetes patients who received eye exams or had their blood sugar monitored among patients with an AQC-participating physician.

In an editorial in the same issue, Lawrence Casalino, M.D., of the Department of Healthcare Policy and Research at Weill Cornell Medical College in New York City, calls the progress of accountable care organizations "promising but not overwhelming."

The AQC program saved an average of $62 per patient in its first year.

In a previous interview with FierceHealthPayer, Dana Gelb Safran, Blue Cross Blue Shield of Massachusetts senior vice president of performance measurement and improvement, explained the potential for cost savings.

"As providers become more aware of differences in pricing--labs, imaging and procedures, for example--they begin to say, 'there is a way to achieve savings on my budget, to move care to less expensive settings.' We're seeing groups both transform and provide better care to patients, so much so that hospital admissions becomes unnecessary," she said.

Some of the improvement comes from hiring staff who check in with patients between visits, she said.

A spillover effect also was noted for Medicare patients, according to a study published in the Journal of the American Medical Association, which was attributed to systemic changes within the provider organization once they join an ACO.

To learn more:
- find the study
- read the editorial
- here's the announcement

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