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Global Budget Payment Model lowers medical spending, improves quality
Date:7/11/2012

utilization of medical services among some groups also contributed to the savings.

Quality of care improvements were also greater in the second year than in the first.

The researchers noted that while the AQC reduced medical spending, the overall dollar amount paid by BCBSMA did not decline. This is because the AQC was designed to include incentives for lower spending and improved quality that may offset reductions in medical spending.

Chernew, however, does not consider this a weakness of the program.

"The intent of the AQC was to achieve savings over the five year duration of the contract," said Chernew. "It was not designed to reduce BCBSMA spending in the first two years. Yet success in the long run requires a change in the culture of medicine in Massachusetts. This study shows that the culture can and will change. For example, in the second year of the AQC, we found both changes in utilization and referral patterns, which suggest physicians are beginning to think and act differently. This study suggests that the delivery system is on a trajectory to be successful, and ultimately it's the trajectory that matters. Continued transformation of delivery systems is crucial and we have to continue to monitor the impact of these cutting edge payment systems. One way or another, providers need to learn to live in a more fiscally constrained environment."

"Historically physicians have felt that when money gets tight, the cavalryin the form of more moneywill arrive. We've reached the point where it's unlikely there will be any cavalry," Chernew added.

"These results are vitally important," said David Cutler, Otto Eckstein Professor of Applied Economics at Harvard University. "We have known there were better organizationshigh quality and low costand worse organizations. But we haven't known how to help organizations get better. These results show us a key path to quality improvement and cost reduction."


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Contact: David Cameron
david_cameron@hms.harvard.edu
617-432-0441
Harvard Medical School
Source:Eurekalert

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