Health plans have increasingly attempted to tie provider reimbursement to quality measures and to costs of providing care, including by placing providers at full risk of the costs of care. One issue regarding such contracts is whether they may disproportionately impact (in a negative way) the care of lower sociodemographic and socioeconomic groups of patients. Research published in Health Affairs suggests that this may not be the case and that in fact, such contracts may be a vehicle to improve quality for such patients. (HA Article) The study used data from 2006 to 2012 in regard to the Alternative Quality Contract implemented by Blue Cross of Massachusetts. This contract both ties reimbursement to quality measures and places providers at two-sided risk for overall costs of care. About 90% of physicians in the network are now covered by these contracts and they appear to be generating cost savings. Patients were divided into socioeconomic groupings by census block and results and trends compared across groupings.
Following implementation of the Alternative Quality Contract, quality measure scores improved faster for the lower socioeconomic groups than for the higher ones, by about 1% per year, although performance on an absolute basis remained somewhat lower, and the gain was in the process measure subset, not the true outcome ones. The difference in scores between the groups is clearly narrowing over time. The source of improvement in quality measures appears to come from adult preventative care and pediatric care measures, with little difference in the chronic condition care measures. All patients covered under the AQC showed better quality measure improvement than that shown by national averages. From a spending perspective, both high and low socioeconomic groups demonstrated a slowdown in growth, but there was not a significant difference in the trend between the two groups. The results suggest that implementation of this type of contract may be most beneficial to lower-income patients.