title: Two-year impact of the alternative quality contract on pediatric health care quality and spending.
abstract: OBJECTIVE
  To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts' global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN.
  
  
  METHODS
  Using a difference-in-differences approach, we compared quality and spending trends for 126,975 unique 0- to 21-year-olds receiving care from AQC groups with 415,331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006-2008) and post (2009-2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending.
  
  
  RESULTS
  During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ~5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children.
  
  
  CONCLUSIONS
  During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group.
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115-5737. alyna.chien@childrens.harvard.edu.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: McNeil
authors.forename: Dana G
authors.initials: DG
authors.lastname: Safran
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics*; D002017:Budgets; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards*; D002675:Child, Preschool; D002908:Chronic Disease; D016638:Critical Illness; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D008404:Massachusetts; D016555:Matched-Pair Analysis; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D057216:Propensity Score; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive; D055815:Young Adult
keywords: ADHD; acute care quality; asthma; capitation; children with special health care needs; chronic disease care quality; pay-for-performance; payment; pediatrics; preventive care