How is the AQC Different from Capitation?
The AQC differs from capitation models of the past in several ways. • The global payment is coupled with a sophisticated yet straightforward set of performance measures through which BCBSMA and providers can ensure that patients are receiving safe, appropriate and effective care. This coupling of payment with performance measures safeguards against undertreatment by documenting and holding providers accountable for both the delivery of appropriate services and the health outcomes associated with those services. Public reporting of physician and hospital performance, which is in development in Massachusetts, will further strengthen that level of accountability. • One of the major criticisms of historical capitation models was that they were not funded adequately. In the AQC, the global budget is based on actual costs and is health status adjusted so that providers are paid a rate that adequately considers the relative morbidity of their patients. The budget is also adjusted annually, in
