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The Early Impact Of The 'Alternative Quality Contract' On Mental Health Service Use And Spending In Massachusetts.


ABSTRACT: Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in participating organizations were slightly less likely to use mental health services and, among mental health services users, small declines were detected in total health care spending, but no change was found in mental health spending. The declines in probability of use of mental health services and in total health spending among mental health service users attributable to the AQC were concentrated among enrollees in organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program's initial years, but organizations are now at varying stages of efforts to improve mental health integration.

SUBMITTER: Barry CL 

PROVIDER: S-EPMC4950854 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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The Early Impact Of The 'Alternative Quality Contract' On Mental Health Service Use And Spending In Massachusetts.

Barry Colleen L CL   Stuart Elizabeth A EA   Donohue Julie M JM   Greenfield Shelly F SF   Kouri Elena E   Duckworth Kenneth K   Song Zirui Z   Mechanic Robert E RE   Chernew Michael E ME   Huskamp Haiden A HA  

Health affairs (Project Hope) 20151201 12


Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Com  ...[more]

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