Changes in Health Care Spending and Quality 4 years into Global Payment

Abstract BACKGROUND: Spending and quality under global budgets remain unknown beyond 2 years. We evaluatedspending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts AlternativeQuality Contract (AQC). METHODS: We compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality. RESULTS: In the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P