Doctors who have agreed to the “alternative quality contract’’ are paid a set monthly fee per patient, adjusted for how healthy the patient is, regardless of how many tests, appointments, and procedures the patient gets. Physicians can earn bonuses for improving care, up to 10 percent of their budget.
Both state and federal officials are pushing for ways to control medical spending, and “global payment’’ models such as the one being used by Blue Cross are considered the most promising.
…Most doctors and hospitals are paid separately for each test, procedure, and office visit, which many believe encourages unnecessary, poorly coordinated care and is driving up costs.
But other doctors and health care executives cautioned against drawing definitive conclusions from the insurer’s early results. They have not been independently reviewed and may not be easily reproduced statewide.
So let’s look at how these providers did in their fist year in three areas: cost, the quality of care and patient satisfaction. On quality, Blue Cross said at least twice as many patients under a global payment got cancer screenings, regular check-ups and kept their diabetes or heart disease under control as did patients in traditional plans.
Doctors at Tufts Medical Center boosted their patient quality scores, in part, by creating a registry of patients with a chronic disease and assigning nurses to track who needed a test or an appointment