BCBSMA introduced its Alternative Quality Contract (AQC) in 2009 and changed a century-old medical reimbursement system from one based primarily on fee-for-service for doctor visits, tests, and hospital admissions to one based on the quality of care, health outcomes, and patient experience. By linking financial incentives to clinical quality, patient outcomes and overall resource use, the AQC has moderated cost growth, while producing significant improvements in the quality of patient care.
CHOIR will be evaluating BCBSMA’s new, explicit incorporation of equity into its AQC, which now provides equity performance data, equity-focused technical assistance, and equity-based financial incentives to help create a direct business case for participants (medical groups and health systems) to make investments and pursue new programs to achieve measurable reductions in racial and ethnic inequities in care.
“There have been few statewide responses by health care payers to incentivize improvements in equity by directly incentivizing the reduction and elimination of racial and ethnic disparities in quality of care as part of risk-based payment arrangements,” said Rodriguez. “Analyses of state and local health policies that encourage ‘whole person care’ indicate that non-medical interventions that address food insecurity, housing instability, and access to reliable transportation are likely needed to address many of the documented racial inequities in quality of care.”
The project being funded by the Commonwealth Fund will evaluate whether health systems and medical groups participating in BCBSMA’s AQC are using team-based care and non-medical interventions that address social needs such as food insecurity, housing, and transportation to reduce disparities in quality of care.
“We posit that reducing racial and ethnic disparities in quality of care and patients’ experiences will require substantial practice-level improvements, entailing significant investment and management attention,” said Rodriguez. “To reduce pervasive racial disparities, AQC participants will likely need to strengthen their care management capabilities, adopt and implement team-based strategies to engage patients, integrate behavioral health services into primary care, screen for social risk factors and referral of patients to community-based services for unmet needs, and use culturally tailored resources.”
The project will also assess how BCBSMA’s equity efforts have impacted external organizations, including BCBSMA’s investments in vendor diversification efforts; grants to community-based organizations to tackle racial inequity; and race, ethnicity, and language preference data collection directly from members.