In the effort to tame health care costs, much hope has been focused on the notion of accountable care, but until recently there has been more optimism than hard evidence that this approach brings about savings.
In accountable care organizations, or ACOs, doctors receive a specific yearly sum to care for a population of patients rather than being paid for each individual test, appointment, or procedure they provide.
As of last year, some 5.3 million Medicare beneficiaries were being cared for under accountable-care arrangements. Add in private patients and the total reaches at least 18 million.
But a new study by Harvard Medical School researchers has concluded that the accountable care effort by the insurance provider Blue Cross Blue Shield of Massachusetts is indeed bending the curve of health care spending. That examination of Blue Cross’s Alternative Quality Contract — which covers some 700,000 people being treated in ACOs — appeared last month in the New England Journal of Medicine.
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Specifically, the study found savings from 5.8 percent to 9.1 percent annually for different populations of patients who got their health care from physicians paid on that basis. Those savings didn’t come at the cost of quality: the preventive, pediatric, and chronic care under the arrangement was judged better than the comparable care delivered to a northeastern control-group population treated on a fee-for-service basis.
Among the reasons for the savings: More care was delivered in lower-cost outpatient facilities, and fewer procedures, tests, and images were ordered.
Less costly care doesn’t always translate into less total spending. For the first three years, incentive payments by Blue Cross to physicians outweighed the savings achieved. But by the fourth year, the Alternative Quality Contract was delivering actual overall savings. That finding is particularly encouraging because no other insurance carrier has used global payments as extensively as Blue Cross.
One study of one insurer doesn’t completely settle the issue, of course. But it does suggest that, over time, innovative payment arrangements can help rein in the cost of health care. It’s a very significant finding, and policy makers should take note.
Date: November 11, 2014