title: Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.
abstract: As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations.
authors.affiliation: Zirui Song (zirui_song@post.harvard.edu) is a resident physician in the Department of Medicine at Massachusetts General Hospital and a clinical fellow at Harvard Medical School, both in Boston.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Sherri Rose is an associate professor of health care policy (biostatistics) in the Department of Health Care Policy, Harvard Medical School.
authors.forename: Sherri
authors.initials: S
authors.lastname: Rose
authors.affiliation: Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy in the Department of Health Care Policy, Harvard Medical School.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.affiliation: Dana Gelb Safran is senior vice president of performance measurement and improvement at Blue Cross Blue Shield of Massachusetts and an associate professor of medicine at Tufts University School of Medicine, in Boston.
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics*; D019352:Censuses; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive / Q000191:economics
keywords: Accountable Care Organizations; Disparities; Physician Payment; Population-Based Payment; Quality Of Care