A Massachusetts affordable care organization was successful at improving patients’ health while lowering costs, according to a study published Oct. 29 in the New England Journal of Medicine.
On the spending side, claims for patients enrolled in the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC) grew an average of $62.21 per enrollee per quarter less than they did in a control group of patients in other states during the 2009-2012 study period, Dr. Zirui Song of Harvard Medical School, Boston, and his colleagues reported.
“Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization,” the investigators wrote. “By 2012, the total payment growth for the AQC (claims and incentive payments combined) was below the Massachusetts state spending target of 3.6% and below the projected spending that was based on controls.”
On the quality side, the “average performance of the 2009 AQC cohort on measures of chronic disease management increased from 79.6% in the period from 2007 through 2008 to 84.5% in the period from 2009 through 2012, as compared with 79.8% and 80.8% in the respective periods for the HEDIS [Healthcare Effectiveness Data and Information Set] national average” (N. Engl. J. Med. 2014:371;1704-14 [doi:10.1056/NEJMsa1404026]).
The authors noted that state payment reform legislation in 2012, as well as Medicare’s Pioneer ACO program, may have affected the latter portion of the analysis, though most reforms did postdate the analysis.
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Claims for ACO-enrolled patients were $62.21 lower per quarter than were claims for patients in the control group.
Although “our findings for 2012 may be susceptible to spillover effects, and anticipatory effects from other contracts may also play a role, our prior analyses that used internal controls, the consistency of the sensitivity analyses, and qualitative findings from interviews with providers suggest that the AQC played a meaningful role,” Dr. Song and his colleagues wrote.
The findings might not translate to the Medicare ACO program since most Medicare ACO contracts “are one-sided with shared savings only. Moreover, prices in Medicare are largely uniform rather than negotiated, so savings for Medicare would require reductions in utilization or shifts to less-expensive settings (rather than referrals to less-expensive providers). Similarly, our results may not be generalizable to other states, which face different constraints and challenges,” they said.
