Medical Group Responses To Global Payment: Early Lessons From The 'Alternative Quality Contract' In Massachusetts
Medical Group Responses To Global Payment: Early Lessons From The 'Alternative Quality Contract' In Massachusetts
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DOI：
10.1377/hlthaff.2011.0264
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发表时间：
2011-09-01
期刊：
影响因子：
9.7
通讯作者：
Chernew, Michael E.
中科院分区：
文献类型：
--
作者：
Mechanic, Robert E.;Santos, Palmira;Chernew, Michael E.
马萨诸塞州最大的保险公司Blue Cross Blue Shield在2009年开始了一项新计划，将全球支付（在特定时间段内为患者群体提供护理的固定支付）与医疗团体的大量潜在质量奖金相结合。在对参与医疗团体的代表进行采访时，其中许多可以被视为原型责任医疗组织，我们发现大多数团体最初专注于两个目标：建立基础设施，帮助初级保健提供者获得高质量的奖金;管理转诊，将患者引导到低成本的环境。各团体正在努力克服众多挑战，其中包括提高数据管理能力;管理收费服务合同中相互冲突的激励措施;建立强调团队合作、以患者为中心的护理和有效管理医疗资源的文化。参与的医疗团体在规模、组织结构和管理式医疗合同的经验方面各不相同。如果这些组织能够成功地在五年合同期内将医疗支出的年增长率降低一半，这可能表明，即使是新成立的负责任的医疗组织也可以从按服务收费转向基于人口的支付模式。
The largest insurer in Massachusetts, Blue Cross Blue Shield, began a new program in 2009 that combines global payments-fixed payments for the care of patient populations during a specified time period-with large potential quality bonuses for medical groups. In interviews with representatives of the participating medical groups, many of which could be considered prototype accountable care organizations, we found that most groups initially focused on two goals: building the infrastructure to help primary care providers earn quality bonuses; and managing referrals to direct patients to lower-cost settings. Groups are working to overcome numerous challenges, which include improving their data management capabilities; managing conflicting incentives in their fee-for-service contracts; and establishing cultures that emphasize teamwork, patient-centered care, and effective stewardship of medical resources. The participating medical groups are diverse in terms of size, organizational structure, and prior experience with managed care contracting. If the groups can succeed in reducing annual growth in health spending by half over the five-year contract, it could signal that even newly formed accountable care organizations can navigate a shift from fee-for-service to population-based payment models.