The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality.
The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality.
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DOI：
10.1377/hlthaff.2012.0327
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Chernew ME
中科院分区：
文献类型：
--
作者：
Song Z;Safran DG;Landon BE;Landrum MB;He Y;Mechanic RE;Day MP;Chernew ME
马萨诸塞州的 7 个医疗服务提供者组织于 2009 年签订了 Blue Cross Blue Shield 替代质量合同，2010 年又有 4 个组织加入。该合同基于全球预算和绩效工资，以实现某些质量基准，使医疗服务提供者面临过度支出的风险，并对其质量进行奖励，类似于 Medicare 中新的先锋责任医疗组织。我们分析了与替代质量合同相关的支出和质量的变化，发现支出的增长率与对照组相比有所放缓。总体而言，与未参与合同的团体相比，参与两年合同的支出节省了 3.3%（第一年 1.9%，第二年 3.3%）。对于以前仅从事按服务付费承包经验的团体来说，节省的成本甚至更高。此类群体两年内的季度储蓄平均为 8.2%（第一年为 6.3%，第二年为 9.9%）。与对照组织相比，参与替代质量合同的组织在这两年中的护理质量也有所提高。慢性病护理管理、成人预防性护理和儿科护理从第一年到第二年在签约组内得到了改善。这些结果表明，全球预算加上绩效工资可以开始减缓医疗支出的潜在增长，同时提高质量。
Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups. Overall, participation in the contract over two years led to a savings of 3.3% (1.9% in year-1, 3.3% in year-2) compared to spending in groups not participating in the contract. The savings were even higher for groups whose previous experience had been only in fee-for-service contracting. Such groups’ quarterly savings over two years averaged 8.2% (6.3% in year-1, 9.9% in year-2). Quality of care also improved within organizations participating in the Alternative Quality Contract compared to control organizations in both years. Chronic care management, adult preventive care, and pediatric care improved from year 1 to year 2 within the contracting groups. These results suggest that global budgets coupled with pay-for-performance can begin to slow the underlying growth in medical spending while improving quality.
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影响因子：
9.7
作者：
Mechanic, Robert E.;Santos, Palmira;Chernew, Michael E.
通讯作者：
Chernew, Michael E.
影响因子：
158.5
作者：
Song, Zirui;Safran, Dana Gelb;Chernew, Michael E.
通讯作者：
Chernew, Michael E.
影响因子：
3.5
作者：
Ellis, Randall P.;McGuire, Thomas G.
通讯作者：
McGuire, Thomas G.
影响因子：
9.7
作者：
Fisher, Elliott S.;Staiger, Douglas O.;Gottlieb, Daniel J.
通讯作者：
Gottlieb, Daniel J.
影响因子：
9.7
作者：
Miller, Harold D.
通讯作者：
Miller, Harold D.