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首页> 外文期刊>The New England journal of medicine >Health care spending and quality in year 1 of the alternative quality contract.
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Health care spending and quality in year 1 of the alternative quality contract.

机译：替代质量合同第1年的医疗保健支出和质量。

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BACKGROUND: In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. METHODS: Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006-2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. RESULTS: Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group--Dollars 15.51 (1.9%) less per quarter (P=0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P=0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. CONCLUSIONS: The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers' ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.).
机译：背景：2009年，马萨诸塞州蓝十字蓝盾（BCBS）实施了一种全球支付系统，称为替代质量合同（AQC）。 AQC系统中的提供者组对支出承担责任，类似于承担财务风险的负责任的护理组织。此外，团体有资格获得质量奖励。方法：七个提供者组织在2009年开始了为期5年的合同，成为AQC系统的一部分。我们分析了2006-2009年针对380,142名主要护理医师（PCP）在AQC系统中的参与者（干预组）和1,351,446名其PCP的参与者的索赔不在系统中（对照组）。我们采用倾向加权的差异差异方法，针对年龄，性别，健康状况和长期趋势进行调整，以比较干预组和对照组之间的支出和质量，从而隔离AQC的治疗效果。结果：2009年，干预组和对照组的平均支出都有所增加，但干预组的参与者的平均支出却有所减少，每季度减少了15.51美元（1.9％）（P = 0.007）。节省的主要原因是门诊服务转向收费较低的设施;来自较低的程序，成像和测试支出;以及减少预期支出最高的注册者的支出。 AQC系统与成人慢性病管理质量（P <0.001）和儿科护理质量（P = 0.001）的绩效改善相关，但与成人预防保健无关。所有AQC小组均达到了2009年的预算目标并获得了盈余。支付给AQC组的BCBS总额（包括质量奖金）可能已经超过了第一年的估计节省。结论：2009年，AQC系统与支出增长的适度放缓和改善的护理质量有关。推荐模式的改变，而不是利用率的改变。 AQC系统对支出增长的长期影响取决于未来的预算目标以及提供商进一步提高实践效率的能力。 （由联邦基金和其他机构资助。）。

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