Blue's model may breathe new life into global cap
In a move that's surely being watched by payers in other states, Blue Cross Blue Shield of Massachusetts (BCBSMA) in Boston plans to stop paying certain doctors and hospitals in its statewide network for each patient visit or treatment and return to capitation.
BCBSMA's alternative quality contract (AQC) represents a new spin on traditional capitation, marrying a global PMPM rate for all physician and hospital services with annual inflation increases and performance incentives linked to nationally accepted measures of quality, effectiveness, and patient satisfaction. Rather than focusing exclusively on cost control-a payer-imposed goal that drove scores of ill-prepared physician practices out of business during the 1990s-the model is designed to help align payment reform, performance measurement, provider and member incentives, and increased cost and quality transparency.
Most Viewed
Most Emailed
- Primary Care Docs Average More Hospital Revenue Than Specialists
- 69% of Employers Plan to Offer Healthcare Coverage After 2014
- How Chargemaster Data May Affect Hospital Revenue
- Insurer's App Aims to Lower Healthcare Costs, Securely
- ED Physicians Key to Half of Hospital Admissions
- Building a Better Healthcare Board
- Q&A: Catholic Health Initiatives' New Senior VP for Capital Finance
- House Lawmakers Grill CMS Over Health Exchange Navigators
- Don't Let Nurses Sink Your Bottom Line
- Hospital Pricing Irks Nurses; More Jobs, Less Pay
