Becker’s Payer Issues Podcast Mark Friedberg, MD, SVP of Performance Measurement & Improvement at Blue Cross Blue Shield of Massachusetts
May 29, 2024
Mark Friedberg, MD from Blue Cross Blue Shield of Massachusetts discusses their 'pay for equity' financial model focused on quality, affordability, and equity in healthcare delivery. They explore the impact of Boston Children's adoption of the model on health outcomes, emphasizing the need to address racial disparities for community health improvement.
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BCBS MA's AQC
- Blue Cross Blue Shield of Massachusetts (BCBS MA) launched the 'Alternative Quality Contract (AQC)' in 2009, similar to an ACO model.
- It predates federal ACO programs and includes upside/downside risk on total medical expense and a quality component.
Prioritizing Health Equity
- In 2020, BCBS MA prioritized health equity, making it co-equal with quality, affordability, and experience.
- This company-wide effort involved various departments, leading to the integration of 'pay for equity' within the AQC.
Pay-for-Equity Structure
- Unlike traditional quality incentives, BCBS MA's 'pay for equity' model doesn't grade providers on a curve.
- Each provider's performance is compared to their own past performance, encouraging collaboration and sharing of equity-improving strategies.