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Payers positioned to lead alternative payment model transformation

Highmark, Capital BlueCross execs share what steps they're taking to implement paying for value instead of volume

Blue Cross Blue Shield of Massachusetts first introduced its alternative quality care contract in 2009, which has the potential to serve as a payment reform "backbone" for other insurers as they increasingly reward quality, efficient care. This type of contract rewards providers financially if they reach certain quality targets and lower costs.

Elsewhere, many organizations use bundled payments as an appealing way to shift high-volume procedures to value-based care models. In fact, bundled payments have been described as the gateway to payment reform, as they emphasize high quality and low costs for patients, providers and payers alike. 

There's still work to be done

Payers may have the leg up on this task, for many commercial accountable care organizations have had a standardized-way of establishing new payment models. For providers, it's an entirely new ballgame. Many don't have a strategy in place nor do they understand how to deal with risk.

"In all good intention, payers have put forth these measures to promote change. But you have to crawl before you can walk," Caron said. "There needs to be more standardization. From a payer side, we need to bring these programs to some similar format so providers know where they're going."

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Alternative quality care contracts can be 'backbone' for payment reform
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How payers, providers make bundled payments work [Special Report]
Bundled payments can be gateway to payment reform