VALUE-BASED CARE · ALTERNATIVE PAYMENT MODELS
The Performance Measurement Lead at BCBSMA
Discusses the Plan’s Bold Payment Model Mark Friedberg, M.D., SVP of performance measurement & improvement at Blue Cross Blue Shield of Massachusetts, discusses the health plan’s bold new health equity-focused payment model By Mark Hagland
O
n Dec. 15, 2022, leaders at the Boston- based Blue Cross Blue Shield of Massachusetts (BCBSMA) announced
a groundbreaking payment model, and with four provider organizations already under contract. The press release began thus: “Blue Cross Blue Shield of Massachusetts (‘Blue Cross’) today announced a milestone in its commitment to ensuring access to high-quality, affordable and equitable care. The not-for-profit health plan is the first in Massachusetts - and among the first in the nation - to create a financial payment model rewarding health systems and physicians for eliminating racial and ethnic inequi- ties in care, with a goal of improving health care for all 2.9 million Blue Cross members. Four of the state’s largest health care systems have signed the agreements, which link financial incentives to improve- ments in health equity: Steward Healthcare Network (‘Steward’), Beth Israel Lahey Health (‘BILH’), Mass General Brigham and Boston Accountable Care Organization, Inc. (‘BACO’), which is part of Boston Medical
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Center. Together, these systems provide care to more than 550,000 Blue Cross members,” the press release noted. “For more than a decade, we’ve col-
laborated with physicians and hospitals via our Alternative Quality Contract, which replaced the fee-for-service model and instead rewards clinicians’ efforts to improve the quality and value of the care they deliver,” Andrew Dreyfus, CEO of Blue Cross, said in a statement included in the press release. “We’re now building on that model to help health systems in our value- based payment programs improve equity. As a health plan, this is the most important tool we have to work toward a health sys- tem that provides affordable, quality and equitable care to all our members.” The press release went on to note that
“The new contracts will initially focus on measuring and rewarding equity in care in several clinical areas where inequities have been identified, including colorec- tal cancer screenings, blood pressure control and care for diabetes. Additional
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categories will be added as the payment model evolves. The Center for Healthcare Organization and Innovation Research (CHOIR) at the UC Berkeley School of Public Health will conduct an independent external evaluation of Blue Cross’ efforts to advance health equity, using qualitative and quantitative methods to examine and publish the effects of this initiative.” And the press release quoted Mark
Friedberg, M.D., senior vice president, performance measurement & improve- ment at BCBSMA, as stating that “We believe nearly all clinicians already want to reduce racial and ethnic inequities in care. By incorporating equity measures into our payment models, we intend to create an explicit business case for large health care systems to increase their investments in developing, expanding and sustain- ing programs that produce measurable improvements in equity.” And, the press release noted, “Friedberg
noted that Blue Cross encourages and sup- ports participating organizations to extend
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