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Health Affairs Article On Alternative Quality Contract Named AcademyHealth Article Of The Year

June 22nd, 2013

Health Affairs is honored that one of our articles has been chosen by AcademyHealth as its article of the year. “The ‘Alternative Quality Contract,’ Based On A Global Budget, Lowered Medical Spending And Improved Quality,” by Zirui Song of Harvard Medical School and coauthors, was published as a Web First on July 11, 2012, and included in the August 2012 issue of Health Affairs.

The Song article will be discussed tomorrow at a session of AcademyHealth’s Annual Research Meeting.  To mark the occasion, we have made the full text of the article freely available to all readers through Sunday, June 30, 2013.

Song’s study provides valuable information as the United States is attempting to move from a fee-for-service health system that pays for quantity toward one that pays for quality. The researchers examined the results of the Massachusetts Blue Cross Blue Shield Alternative Quality Contract (AQC), a multiyear contract that began with seven provider organizations in 2009; an additional four organizations joined in 2010. The AQC paid providers using a global budget, similar to some Accountable Care Organizations formed under the Accountable Care Act.

The authors found that savings in total medical spending associated with the Alternative Quality Contract were 1.9 percent in the first year and 3.3 percent in the second year. Savings were achieved through lower prices from shifting procedures, imaging, and tests to providers with lower fees and through reduced utilization among some groups. Song and his colleagues also analyzed the effect of the AQC on quality of care, finding that improvements in chronic care management, adult preventive care, and pediatric care were larger in the second year than in the first year.

According to AcademyHealth,

The Article-of-the-Year award recognizes the best scientific work that the fields of health services research and health policy have produced and published during the previous calendar year. The award-winning article provides new insights into the delivery of health care and advances knowledge of the field.

In addition to Song, article authors include Dana Gelb Safran, Bruce Landon, Mary Beth Landrum, Yulei He, Robert Mechanic, Matthew Day and Michael Chernew.

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1 Response to “Health Affairs Article On Alternative Quality Contract Named AcademyHealth Article Of The Year”

  1. jimrecht Says:

    That this deeply flawed and misleading paper should be so celebrated is disappointing and, frankly, worrisome.

    It is disappointing because, despite its bizarrely counterfactual title, the paper actually describes a study in which the experimental group (the ACO-like Blue Cross plan) increased healthcare spending relative to the control (a traditional fee-for-service population). Any but the most cursory reading of this paper reveals that the authors achieve their smoke-and-mirrors results by defining “Total Medical Spending” one way for the ACO and another way for the control population. So, for example, all payments from Blue Cross to the fee-for-service providers are included, while for the ACO population, the actual capitation payment — as well as the pay-for-performance payments that are part of this model — are simply omitted.

    It is worrisome because, as Dr.’s Nardin, Woolhandler and Himmelstein pointed out elsewhere in this journal, “the fact that the AQC failed to [lower costs] was probably overlooked by many readers and was clearly lost in media reports of these findings and hence in the policy debate.”

    Yours Truly,
    Jim Recht, MD

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