Costs and quality in #Massachusetts: What works and what doesn’t #hr #hr2

WBUR on Partner’s program:

Diabetes is one of five conditions Partners is tackling in this first phase of its care redesign phase. (See a PowerPoint here.) For the second phase, heart conditions, Partners plans to improve follow-up care and avoid hospital re-admissions.

With stroke, Partners may create a center that would identify patients at risk….  Some of these changes may not sound dramatic, but they have helped other large health systems around the country control spending and improve care.

Two studies from Harvard via the NEJM. (Forgive the barrage of acronyms.)

Harvard researchers on ACOs in NEJM:

The vision underlying the ACO movement — of provider accountability
that goes beyond delivering an individual service and of care that is
integrated and patient-focused — is one worth pursuing with bold steps. CMS has
many good ideas in its ACO proposal. We believe that the final risk-sharing
methods should build off this model — retaining the possibility of losses as
well as savings — but front-load the benefits more and provide the tools and
flexibility that provider groups will need to rationalize the delivery of
medical care. Of course, the regulations are just the beginning of bringing
ACOs to Medicare. CMS will have to develop capabilities to work in new ways
with providers, sharing data and information in a timely manner, supporting
change with technical assistance, and monitoring patient care for potential
adverse consequences.

 More Harvard researchers on BC/BS of MA and its experimental global
payment program:


In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a
global payment system called the Alternative Quality Contract (AQC). Provider
groups in the AQC system assume accountability for spending, similar to
accountable care organizations that bear financial risk. Moreover, groups are
eligible to receive bonuses for quality…


The AQC system was associated with a modest slowing of
spending growth and improved quality of care in 2009. Savings were achieved
through changes in referral patterns rather than through changes in
utilization. The long-term effect of the AQC system on spending growth depends
on future budget targets and providers’ ability to further improve efficiencies
in practice.


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