The companies said that the programme will move private health plan reimbursement for hospitals away from the volume of care they provide patients to the value of care they provide. Hospitals tend to be paid based on volume, including fees for each admission, test and procedure, which can result in unnecessary medical care and an increased administrative burden.
Under the new programme, which builds on the Alternative Quality Contract, the financial reward system for a hospital will be linked to its success in working with physician groups in its immediate geographic area to provide high-quality, cost-effective care.
“This is true, community-based population health,” said Blue Cross President and CEO Andrew Dreyfus. “Blue Cross is committed to providing the data, support, and financial incentives to help hospitals improve care and lower costs for everyone who comes through their doors, regardless of primary care affiliation. We're confident this model will encourage hospitals to unleash the creativity to look at new and different ways of keeping their communities healthy. We're excited to partner with South Shore Health System on this innovative programme, deepening our shared commitment to making quality healthcare affordable.”