Two-year impact of the alternative quality contract on pediatric health care quality and spending

Pediatrics
Alyna T ChienMark A Schuster

Abstract

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. 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. 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...Continue Reading

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Citations

Mar 14, 2017·Academic Pediatrics·Alyna T ChienMark A Schuster
Nov 7, 2016·Medical Care Research and Review : MCRR·Anthony ScottJongsay Yong
Dec 13, 2017·Medical Care Research and Review : MCRR·Brystana G KaufmanEmily C O'Brien
Jul 6, 2018·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·F P VlaanderenP P T Jeurissen
Dec 8, 2016·Health Care Management Review·Valerie A LewisAleen Cunningham
Dec 27, 2019·Critical Care Medicine·Amy L Sanderson, Jeffrey P Burns
Jun 21, 2019·Medical Care Research and Review : MCRR·Daniëlle Cattel, Frank Eijkenaar
Oct 23, 2015·Medical Care·Deborah KorensteinSalomeh Keyhani
Sep 15, 2016·Hospital Pediatrics·David A PaulDeborah Ehrenthal
Mar 25, 2020·Critical Care Medicine·Amy L Sanderson, Jeffrey P Burns
Jun 23, 2018·Academic Pediatrics·Alyna T ChienMark A Schuster
Jun 3, 2015·Pediatrics·Robert SegeMargot Kaplan-Sanoff

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