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The Children's Hospital Integrated Care Organization (CHICO), which includes Children's Hospital Boston, Children's Physicians' Organization (PO) and the Pediatric Physicians' Organization at Children's (PPOC), signed a new agreement with Blue Cross Blue Shield of Massachusetts (BCBSMA). The main achievements of the contract include modest rate increases below general inflation over the three-year contract and establishment as the first pediatric-only Alternative Quality Contract (AQC) provider. The agreement represents another step in Children's and its physicians' long-term effort to improve care while keeping it affordable.
"This is a real opportunity for us to rethink the way we deliver care," says Gregory J. F. Young, MD, president and CEO of the PPOC. "We're looking forward to deeper clinical integration with the hospital and its staff." Dr. Young concludes that without the dedication and commitment of all the clinicians across primary and specialty care, the contract would not have been possible. "We look forward to meeting and exceeding the quality measures, as we continually seek to innovate and improve care for the families we serve."
Under the new agreement, Children's and its physicians reduce their growth in payments from BCBSMA, compared to the previous contract, by $83 million over the three-year contract. Building on the $32 million Children's and its physicians returned to BCBSMA in 2010 and 2011 through rate reductions and price cuts, the total savings to consumers and employers from 2010 to 2014 will be $115 million.
BCBSMA's AQC, a model based on both global payment and pay-for-performance quality measures, emphasizes increased coordination of care and improved care quality through better alignment of financial and clinical goals. Children's and its primary care physicians and specialists worked with BCBSMA to make the AQC work for kids by having robust pediatric quality measures, including local and national comparators ranging from well-child care to sup-specialty care of complex patients.
Through this contact, Children's and its physicians are taking on significant risk based on pediatrics-specific quality and utilization goals. Over the life of the contract, Children's and its physicians will be held accountable for performance compared to external benchmarks on 21 patient quality measures, while keeping cost growth below BCBSMA's pediatric network average. For example, primary care metrics will measure timely patient well visits across all age groups and patient experience. Children's and its physicians also pushed for additional pediatric—specific measures, such as how well patients with cystic fibrosis maintain good lung function, preventing complications after appendectomies and preventing blood stream infections in patients on the cardiac, neonatal and medical/surgical intensive care units.
Children's and its physicians continue a long-standing commitment to addressing the rising cost of health care for our patients, regardless of their insurance plan or their pediatrician's participation in capitation agreements. With over 200 projects underway, such as the Home Ventilation Program and the headache collaborative, Children's and its physicians are working to transform the clinical—and cost-effectiveness of care across settings and pediatric conditions for all patients.
More information:
childrenshospital.org/value
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Children's Hospital Boston and its physicians are pursuing an aggressive strategy of reducing the overall cost trend, while improving pediatric care:
- Since 2009, through a combination of institutional efficiencies, care delivery innovations, reducing unnecessary utilization while improving quality, moving care to lower-cost settings and better integration, Children's and its physicians have taken more than $125 million out of the health care system to benefit employers and consumers.
- Children's created a unique partnership with its major payers, titled the Provider-Payer Quality Initiative (PPQI), which advances the evolution of the pediatric health care system and promotes long-term cost reductions. PPQI has awarded grants to innovative programs aimed at creating transformative cost-saving improvements in pediatric care.
- In 2009, the Pediatric Physicians' Organization at Children's launched the Medical Home Initiative to help make pediatric care better coordinated, more accessible and more affordable for our patients
and families.
- In 2010, Children's voluntarily reduced our prices for laboratory testing, ambulatory visits, radiology, surgery and hospital admissions to further reduce health care spending.
The new pediatric-focused Alterative Quality Contract is yet another step toward improving quality and slowing the growth of health care costs.
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