Massachusetts Blues claims success with global payments

Blue Cross Blue Shield of Massachusetts is claiming success with paying physicians under a global payment system in which doctors are paid a flat per-patient rate, but earn bonuses based on meeting clinical quality benchmarks.

Every group participating in the system -- a third of the plan's network -- met its budget, saved money for the practice and earned bonuses based on quality-of-care scores, according to the Massachusetts Blues.

The assertion comes after, upon the plan's request, experts evaluated its "Alternative Quality Contract," introduced in January 2009. The results were published in the January issue of Health Affairs (link).

The Blues said the results are helping to bring more physicians to the AQC.

"We are experiencing significant growth in the AQC, and we know that non-AQC providers are feeling pressure to join," Blues spokeswoman Jenna McPhee said in a statement.

The five-year contracts give a group of physicians or health system a budget to care for a group of patients and allow for yearly bonuses based on clinical quality scores.

The report in Health Affairs was released as state lawmakers in Massachusetts draft legislation that would shift the state away from fee-for-service payments for health care and toward a system such as the Alternative Quality Contract.

Physicians with the Massachusetts Medical Society have supported experimentation with payment methods other than fee-for-service, but continue to call for a gradual transition away from the current model.

"Flexibility is key, just like we have a diversity of different clinical settings," said MMS President Alice Coombs, MD, a critical care specialist and anesthesiologist who practices in Weymouth, Mass.

Dr. Coombs said a bill that would make that change could be introduced in a few weeks. She represented MMS as a member of the Massachusetts Special Commission on the Health Care Payment System, which voted unanimously in July 2009 to support such a change.

Coombs said physicians need to have the option of continuing under a fee-for-service system if it makes more sense because not every specialty -- for example, emergency medicine -- is suited to working under global payment arrangements.