The finding that did not surprise doctors involved in accountable care research and operations.
“It does make sense,” said Dr. Richard Parker, chief medical officer of Beth Israel Deaconess Care Organization, Boston, an accountable care organization that includes the Beth Israel Deaconess Medical Center.
The study analyzed healthcare spending and quality for Medicare patients treated by providers participating in a Massachusetts Blues commercial accountable care contracts. The Blues contracts, first introduced in 2009, include incentives to control spending and meet quality target, and data published in Health Affairs last fall found a drop in spending (3.3% for the second year) and better quality.
Results for Medicare patients during the same period show a drop in spending (3.4% in year two) compared with projected spending based on trends from a control group.
But quality gains were confined to two cholesterol screening measures for diabetics and heart disease patients. The researchers look at seven quality measures.
The cost and manpower needed to create programs that improve quality can also limit their enrollment, Parker said. Accountable care provides financial incentives for such investments, but those incentives are limited.
Doctors have an easier time reining in costs, said Parker. For example, doctors may reduce spending by more judicious use of some commonly overused laboratory or imaging tests.
Dr. J. Michael McWilliams, an assistant professor of healthcare policy and medicine at Harvard University and one of the study's three authors, said information technology has also helped to make changes in delivery that slow spending more broadly than targeted interventions for patients with gaps in care or complex medical needs.
McWilliams, also a practicing physician at Brigham and Women's Hospital, said an example of more systemic, cost-savings strategies might be electronic medical records that now contain alerts when doctors order an overused test, such as imaging for low-back pain.
Declines in spending for imaging, minor outpatient procedures and office visits accounted roughly one-third of the spending slowdown among Medicare patients cared for by the providers in the Blues accountable care organization contracts.
Such technological interventions “don't discriminate based on insurance,” McWilliams said.
Blue Cross Blue Shield of Massachusetts officials were also unsurprised by the results.
Patients outside the accountable care contract, such as those enrolled in Medicare, do not have the benefit of data analysis the insurer provides to improve quality, said Dana Gelb Safran, senior vice president for performance measurement and improvement for Blue Cross Blue Shield of Massachusetts.
Monthly data provided by the Massachusetts Blues to doctors with accountable care contracts helps physicians quickly identify patients who need follow up or further care, she said. Access to timely data allows doctors to spot gaps in care that can undermine quality.
The insurer's internal data underscores the value of the data. Blues members not included in accountable care contracts, those in preferred provider organizations, have not seen the same quality gains as Blues members in health maintenance organizations who are included in the contracts. To remedy that gap, the insurer is moving this year to provide data to PPOs and starting in January will introduce financial incentives for PPOs tied to quality and spending.
