Early Results From a Value-based Provider Contract

Massachusetts Blue Cross has used an “Alternative Quality Contract” with provider groups for several years.  Prior research suggests that it has had modest cost or quality impacts and a new study carried by Health Affairs looks at the effect on mental health services.  (HA Article)  The researchers compared receipt of mental health services by members covered by the AQC with a similar group under more traditional provider contract arrangements.  Under the AQC, providers are paid a fixed, risk-adjusted amount for all primary and specialty care for members choosing the provider.  This method could encourage providers to limit services, but the AQC also provides bonuses for meeting quality measure targets, which could ameliorate any effect from the financial incentive to control utilization.  For mental health in particular, where utilization is often inappropriate or ineffective, being at risk might encourage a provider to carefully control services or to more fully integrate behavioral and primary care, which has been shown to result in better outcomes for patients.    Among those AQC providers who were at risk for mental health services, there was a slight decline in both mental health visits and spending, compared to those providers not at risk for such services.  The patients who used mental health services had comparable performance on quality measures related to diabetes and cardiovascular care to patients who did not use mental health services, suggesting that care neither worsened nor improved for these patients.  A set of providers and others who were interviewed about the use of mental health services under the AQC basically said it had no impact.  Factors in this were a focus on other issues like “code capture” (i.e., risk payment revenue maximization), limited ability of the chosen behavioral health quality measures to incent changes in care, and limited mental health provider capacity and capabilities.  In general, value-based purchasing methods are being oversold on their ability to affect change.