Alternative payment model improved quality of care for some patients

Patients who received care from providers who offered alternative payment models experienced improvement in quality of care, with the greatest gains reported among patients in lower socioeconomic status areas, according to researchers from Harvard Medical School. The research is published in Health Affairs.

The program, Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (AQC), is a population-based model that pays health care providers a lump sum to cover all the costs of a patient’s care, as opposed to traditional systems, which pay for each service provided.

“On average, quality of care improved for all members in the AQC, but we noticed a larger improvement for members who live in areas with lower socioeconomic status,” Zirui Song, MD, PhD, a resident physician at Massachusetts General Hospital, clinical fellow at Harvard Medical School and lead author of the study, said in a press release.

Researchers compared changes in health care quality, outcomes and total spending between patients of lower and higher socioeconomic status areas enrolled in the AQC, both before and after their providers entered the AQC. While spending for different groups was similar, quality improvements were greater for low-income patients compared to those with higher incomes.

Accordioning to the release, measures that involved adult preventive care, pediatric care and chronic disease management improved an average of 1.2 percentage points among members in lower socioeconomic areas than for those in higher socioeconomic areas in the first 4 years of the AQC.

“Our findings are encouraging because they suggest payment models that emphasize and reward quality of care, outcomes and cost could provide the right mix of incentives that motivate providers to improve care for disadvantaged populations,” Michael Chernew, PhD, a professor of health care policy at Harvard Medical School and coauthor of the study, said in the release.


Song Z, et al. Health Aff. 2017;doi: 10.1377/hlthaff.2016.0682.

Disclosure: The researchers report funding from a National Institute on Aging MD/PhD National Research service award and a grant from the Commonwealth fund.

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