Global payments yield 'modest' savings


Blue Cross Blue Shield of Massachusetts' own version of a global payment system, called the alternative quality contract (AQC), has produced "modest" savings in its first year and improved quality of care in some areas, according to a study published in the New England Journal of Medicine.

During the first year of the AQC, average medical spending increased for enrollees treated by both doctors paid under the AQC and by doctors paid by traditional fee-for-service. The difference, however, was that the increase was 1.9 percent smaller for enrollees in the AQC, which gives doctors a set amount each year to spend on each patient, notes the Boston Globe. The savings were primarily achieved by shifting outpatient care to providers who charged lower fees and were seen largely among high-risk enrollees, accoring to the study.

Researchers also discovered that for physicians and hospitals with no previous experience in a global payment model, spending was 6 percent lower than that of fee-for-service providers.

"Sustainability of the AQC and the financial viability of the model for providers will ultimately depend on identifying and addressing clinically inefficient care and changing utilization patterns," the study authors wrote.

This study contradicts an earlier study conducted by the state attorney general's office, which found that the state's global payment system, of which Blue Cross' AQC is a specific type, had not saved money in its first year.

To learn more:
- read the study (.pdf)
- here's the BCBSM/Harvard press release
- see the Boston Globe story
- check out the Cardiovascular Business piece
- view the Becker’s Hospital Review story

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