It puts medical providers on a budget to care for about 150,000 Medicare patients and replaces some of the basic financial carrots of health care. This kind of arrangement - known as an accountable care organization - offers medical providers financial incentives to save money on the overall cost of patient care and penalizes them when those costs run too high. It also measures the quality of care delivered by doctors - everything from medical outcomes to patient perceptions about the care they receive.
Big players in the Boston medical establishment applied for the Pioneer program and were accepted by the government. That includes Partners HealthCare, Steward Health Care System, Atrius Health, and the Beth Israel Deaconess Physician Organization - four of the five leading hospital/physician organizations in Eastern Massachusetts. The Mount Auburn Cambridge Independent Practice Association is the fifth local group participating in the program.
The basic idea is not new: A version of it has been pitched aggressively to hospitals and physician groups for several years by Blue Cross Blue Shield of Massachusetts as a way to cope with rising medical costs. The Blue Cross Alternative Quality Contract, widely known as the AQC, is similar to Medicare’s Pioneer plan.
In fact, about two out of every three primary care doctors and four of every five specialists in Massachusetts participate in the Blue Cross AQC. They already care for some of their patients, about 700,000 in all, under that arrangement. That’s far more than the number of people who will receive care under the Medicare Pioneer program.
All five Massachusetts medical groups selected for the Medicare program already operate under a Blue Cross alternative quality contract to some degree. (Partners had just recently become involved.)
