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Global Budgets and Technology-Intensive Medical Services.

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    The Alternative Quality Contract (AQC) increased colonoscopy use and reduced spending on cardiovascular and imaging services by shifting care to lower-cost options. Orthopedic services showed no significant impact.

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    Area of Science:

    • Health Economics
    • Healthcare Policy
    • Medical Technology Assessment

    Background:

    • Global payment models aim to control costs and improve quality in healthcare.
    • The Alternative Quality Contract (AQC) was implemented by Blue Cross Blue Shield of Massachusetts in 2009-2010.
    • The study examines the AQC's impact on high-value (colonoscopies) and potentially overused services (cardiovascular, imaging, orthopedics).

    Purpose of the Study:

    • To evaluate the impact of the Alternative Quality Contract (AQC) on healthcare spending and utilization.
    • To assess changes in the use of colonoscopies, cardiovascular, imaging, and orthopedic services under the AQC.
    • To understand how global payment models influence the adoption of medical technologies.

    Main Methods:

    • Utilized a propensity-weighted difference-in-differences approach.
    • Analyzed data from approximately 420,000 enrollees in 2009 and 180,000 in 2010.
    • Adjusted for enrollee demographics, health status, secular trends, and cost-sharing using three years of pre-intervention data.

    Main Results:

    • Colonoscopy volume increased by 5.2% in the first two years of the AQC.
    • Total spending on cardiovascular services decreased by 7.4%, and imaging services by 6.1%.
    • Decreases in spending were attributed to lower utilization of high-priced services and a shift to lower-priced providers; no effect on orthopedics.

    Conclusions:

    • The AQC demonstrated higher utilization of colonoscopies, a high-value service.
    • The global payment initiative generally shifted volume towards lower-priced facilities or services for potentially controversial categories.
    • Global payment models can influence healthcare resource allocation and cost management.