Managed Healthcare Executive - March 2009 - (Page 13) an improvement over traditional capitation in three ways: It aims to reimburse fairly by considering actual costs and by adjusting payment for health status and in ation; It safeguards against underutilization of services by holding physicians and hospitals accountable for performance measures; and It makes physicians and hospitals jointly accountable, so neither is tempted to withhold necessary care. The AQC performance measures include a total of 39 process measures (19 for ambulatory care and 20 for hospital care), 13 outcomes measures ( ve for ambulatory and eight for hospital), and 12 patient-experience measures, including BCBSMA presented its AQC to hospital and health system leaders, health economists and bene t consultants before o ering it to delivery partners this year. According to Dreyfus, quality thought leader Don Berwick, president and CEO of the Institute for Healthcare Improvement, called the AQC “innovative and welcome news.” Though it’s too soon to measure the e ectiveness of AQC, Dreyfus says providers have reacted positively. He anticipates that over the next few years at least 15% to 20% of the plan’s provider network will buy into the model. Since January, three hospitals, including Tufts Medical Center, have signed an AQC. According to Clough, more than 70% of its female patients receive mammograms. The goal, she says, is to boost that gure to at least 90% through new patient education programs and tools. Under the parameters of the AQC, providers are also entitled to keep all savings associated with any systemic e ciencies they achieve—ultimately expanding their operating margins. Spurred by this, Mount Auburn is investing $750,000 to complete the installation of an electronic health record. or who is going to lose, but it’s who is going to put something forward.” —Anne-Marie Audet, MD “It’s not who is going to win those used for CAHPS and H-CAHPS (eight for ambulatory and four for hospital care). In September 2008, while BCBSMA’s model for the AQC was nearing completion, Dreyfus testi ed before the Senate Finance Committee to make a case for greater support of quality-improvement initiatives. “We already had one of the most advanced and sophisticated pay-for-performance programs in the country for both hospitals and physicians,” says Dreyfus, who is responsible for the company’s health and wellness, performance and improvement, and provider contracting and services. “It’s a hybrid combining the best features of global payment and pay for performance.” Mount Auburn Hospital, a Harvard-a liated teaching hospital based in Cambridge, Mass., now operates under an alternative quality contract with BCBSMA. Jeannette Clough, president and CEO of Mount Auburn, says the hospital collaborated with the plan in its due diligence before the model ofcially launched. She says the hospital has a lot of work ahead to meet the quality standards of the AQC, particularly when it comes to preventive care, which is one of the critical aspects of the model. For example, Mount Auburn has set a goal to increase the number of mammograms and colonoscopies it administers to patients among its other preventive e orts to meet the AQC guidelines. SOPHISTICATED P4P Anne-Marie Audet, MD, is the assistant vice president for quality improvement for the Commonwealth Fund. She previously worked for the Massachusetts Peer Review Organization Inc., where she was responsible for statewide collaborative projects that demonstrated measurable improvement in the quality of care provided to Medicare bene ciaries. Dr. Audet predicts that because of rapidly rising costs, more sophisticated pay-for-performance schemes, such as the AQC, will surface. She says that as she comes into contact with more stakeholders, she senses an increased air of negotiation, which comes from stark economic necessity. “It’s not who is going to win or who is going to lose, but it’s who is going to put something forward,” Dr. Audet says. One of broadest government-supported quality collaborations is HHS’ Chartered Value Exchange program. Last year, the department recognized two dozen quality groups across the country and gathered them into a learning network with support from AHRQ. Generally, the multi-stakeholder organizations are nonpro ts and provide healthcare quality data to their local communities. Marc Overhage, MD, PhD, president and CEO of the Indiana Health Information Exchange (IHIE), one of MARCH 2009 13
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