Massachusetts Payment Reform Model: Results and Lessons
The initial findings of a longitudinal assessment of AQC results, conducted by Michael Chernew, Ph.D. and his colleagues at Harvard Medical School and supported by the Commonwealth Fund, echo these results. Their year-one findings, published in the New England
Journal of Medicine, showed that the AQC was associated with significant quality improvement and two percent slower growth in medical spending in 2009.
The research team’s analysis of the second year, published in the journal Health Affairs, found that the savings among AQC groups in the second year was even greater—3.3 percent higher relative to the rest of the network. The savings were more dramatic among AQC groups that had been paid on a fee-for-service basis before the contract. AQC provider groups in this category achieved a first-year savings of 6.3 percent and second-year savings of almost 10 percent. For 2009 and 2010, the AQC groups were able to reduce spending
largely by referring patients to lower-cost facilities for services, such as imaging and lab testing, and by reducing these areas of utilization.
Evidence from interviews of physician leaders, primary care providers, and specialists at all types of AQC groups, large and small, suggests that the global budget model enables sustainable changes in the way groups and individuals practice. Among the most common themes:
1) the AQC’s aligned quality and efficiency incentives create an environment where there is much more communication, coordination, and integration between primary care providers and specialists, and between physician groups and participating hospitals; 2) more attention is paid to quality indicators, transitions of care, preventable complications, and variations in practice related to overuse, underuse, or misuse of tests and procedures; 3) extra resources are available to build new infrastructure and information systems; employ more nurses and medical assistants; offer patients extra preventive care, rehabilitation care, and consultation about medication use; 4) and, as one AQC physician leader put it: “Our physicians spend much more time than in the past trying to help patients get their care in the most appropriate setting, and explaining to patients what they want them to do and why.”
Further, since AQC providers are accountable for the cost of all care their patients receive, whether the care is delivered by a provider within the AQC group or not, we are seeing important changes in referral patterns. Primary care providers have an incentive to look for specialists and facilities that provide high quality at a lower cost when sending their patients for testing or a referral, so the AQC has the potential to drive value throughout the delivery system.
