Changes in Health Care Spending and Quality 4 Years into Global Payment

In the first 4 years of the Alternative Quality Contract used by Blue Cross Blue Shield of Massachusetts, lower spending growth and greater quality improvements were observed for AQC enrollees than for enrollees in employer-sponsored plans in eight other states. To slow the growth of health care spending, insurers are moving toward global budgets. Increasingly, physicians are forming or joining accountable care organizations (ACOs) to take on such contracts. 1 – 3 As of 2014, Medicare has entered into ACO agreements with 360 physician organizations caring for 5.3 million beneficiaries. 4 Combined with a similar growth in the private sector, an estimated 18 million persons in the United States have insurance coverage in which their physicians are in ACO arrangements. 5 Massachusetts was an early adopter of payment reform. 6 One of the first developments occurred in 2009, when Blue Cross Blue Shield of Massachusetts . . .