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Alternative Quality Contract: Improving Health Care Quality While Reducing Spending Growth. Alliance for Health Reform Deborah Devaux Monday, August 10, 2009. Transformation Vision: 2016.

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Alternative Quality Contract:Improving Health Care Quality While Reducing Spending Growth

Alliance for Health Reform

Deborah Devaux

Monday, August 10, 2009


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Transformation Vision: 2016

A health care system that provides safe, timely, effective, affordable, patient-centered care for everyone in Massachusetts.


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Cornerstones of the Alternative QUALITY Contract

The Alternative QUALITY Contract model is composed of key components that are standard across provider entities

  • Integration across the continuum of care

  • Accountability for performance measures (ambulatory and inpatient)

  • Global payment for all medical services (health status adjusted)

  • Sustained partnerships (5 year contract)

    This will lead to …

  • New products differentiating Alternative QUALITY Contract providers

  • Member incentives to encourage healthy behaviors


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Key components of the alternative contract model

Unique contract model:

  • Physicians & hospital contracted together as a “system” – accountable for cost & quality across full care continuum

  • Long-term (5-years)

    Controls cost growth:

  • Global payment for care across the continuum

  • Annual inflation tied to CPI

  • Incentive to eliminate clinically wasteful care (“overuse”)

  • Improved quality, safety and outcomes:

  • Robust performance measure set creates accountability for quality, safety and outcomes across continuum

  • Substantial financial incentives for high performance (up to 10% upside)

Expanded Margin Opportunity

Efficiency Opportunity

Inflation

Performance

INITIAL GLOBAL PAYMENT LEVEL


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How Is this Different from Capitation?

  • Includes a significant upside potential based on a sophisticated set of measures that address patient safety, appropriateness of care and patient satisfaction

  • Initial payment level is derived from the historical experience of the provider group.

  • Payment is adjusted annually in line with inflation

    • Global payment is not reset annually

    • Providers can retain margins derived from reduction of inefficiencies

  • Payment is health status adjusted to adequately consider changes in patient morbidity


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Clinical process measures

Acute MI

Heart Failure care

Pneumonia care

Surgical care

Clinical outcomes measures

Hospital-acquired infections

Complications after major surgery (AMI, PE/DVT, Pneumonia)

Obstetric trauma

Patient Care Experiences

Communication quality: physicians

Communication quality: nurses

Responsiveness

Discharge support/planning

Developmental Measures

Measure # 1

Measure # 2

Performance Measures For The AQC

Hospital Quality and Safety

Ambulatory Care Quality

  • Clinical process measures

    • Depression

    • Diabetes

    • Cardiovascular Disease

    • Cancer Screening

    • Pediatric: Appropriate Testing / Treatment

    • Pediatric: Well Child Visits

  • Clinical outcomes measures (triple-weighted)

    • Diabetes (HbA1c, LDL-c and BP control)

    • Hypertension (blood pressure control)

    • Cardiovascular Disease (BP control, LDL-c control)

  • Patient Care Experiences

    • Quality of clinical interactions

    • Integration of care

    • Access to care

  • Developmental Measures

    • Measure # 1



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Provider Feedback

Transition and management support

Risk accountability

Member communications alignment

PCP responsibility


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Massachusetts Payment Reform Commission

Global payment as predominant form of payment

Transition not to exceed five years

Careful transition with infrastructure

Create new independent Board to implement

Complementary strategies

  • health plan design

  • evidence based coverage

  • consumer engagement (lifestyle; self-management)

  • administrative simplification

  • medical malpractice reform

  • end of life care

  • primary care workforce development