Harvard Medical School, Boston, Massachusetts, USA.
Health Aff (Millwood). 2011 Jan;30(1):51-61. doi: 10.1377/hlthaff.2010.0980.
In January 2009 Blue Cross Blue Shield of Massachusetts launched a new payment arrangement called the Alternative Quality Contract. The contract stipulates a modified global payment (fixed payments for the care of a patient during a specified time period) arrangement. The model differs from past models of fixed payments or capitation because it explicitly connects payments to achieving quality goals and defines the rate of increase for each contract group's budget over a five-year period, unlike typical annual contracts. All groups participating in the Alternative Quality Contract earned significant quality bonuses in the first year. This arrangement exemplifies the type of experimentation encouraged by the Affordable Care Act. We describe this unique contract and show how it surmounts hurdles previously encountered with other global-payment models.
2009 年 1 月，马萨诸塞州蓝十字蓝盾公司推出了一种名为“替代质量合同”的新支付安排。该合同规定了一种修改后的全球支付（在特定时间段内为患者护理支付固定款项）安排。该模式与过去的固定支付或人头费模式不同，因为它明确将支付与实现质量目标联系起来，并为每个合同组在五年内的预算增长率设定了上限，这与典型的年度合同不同。参与替代质量合同的所有团体在第一年都获得了可观的质量奖金。这种安排体现了《平价医疗法案》所鼓励的那种试验类型。我们描述了这种独特的合同，并展示了它是如何克服以前遇到的其他全球支付模式的障碍的。
