title: Cost and quality trends in direct contracting arrangements.
abstract: This paper presents the first empirical analysis of a 1997 initiative of the Buyers Health Care Action Group (BHCAG) known as Choice Plus. This initiative entailed direct contracts with provider-controlled delivery systems; annual care system bidding; public reports of consumer satisfaction and quality; uniform benefits; and risk-adjusted payment. After case-mix adjustment, hospital costs decreased, ambulatory care costs rose modestly, and pharmacy costs increased substantially. Process-oriented quality indicators were stable or improved. The BHCAG employer-to-provider direct contracting and consumer choice model appeared to perform reasonably well in containing costs, without measurable adverse effects on quality.
authors.affiliation: Health Systems Management faculty, School of Public Affairs, University of Baltimore, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Lyles
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shore
authors.forename: Jon
authors.initials: J
authors.lastname: Christianson
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Patricia
authors.initials: P
authors.lastname: Drury
mesh_terms: D003258:Consumer Behavior / Q000191:economics; D003284:Contract Services; D003363:Cost Control / Q000379:methods; D017754:Group Purchasing / Q000191:economics / Q000458:organization & administration*; D006264:Health Benefit Plans, Employee / Q000458:organization & administration* / Q000592:standards; D006265:Health Care Coalitions / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008910:Minnesota; D019982:Organizational Case Studies; D019984:Quality Indicators, Health Care