Appendix A: Measures Included in the AQC Contracts Launched in 2009, 2010, and 2011

AmbulatoryMeasures / HospitalMeasures
Process / Depression AMI
1Acutephase Rx 1 ACE/ARB for LVSD
2ContinuationPhaseRx 2 Aspirin at arrival
Diabetes 3 Aspirin atdischarge
3HbA1ctesting (2X) 4 BetaBlocker at arrival
4Eyeexams 5 BetaBlocker at discharge
5Nephropathy screening 6 Smokingcessation
CholesterolManagement Heart Failure
6Diabetes LDL-Cscreening 7 ACE LVSD
7Cardiovascular LDL-C screening 8 LVS function evaluation
Cancer Screening 9 Dischargeinstructions
8Breast cancerscreening 10 Smokingcessation
9Cervical cancerscreening Pneumonia
10Colorectal cancerscreening 11 Fluvaccine
Preventive Screening/Treatment 12 Pneumococcal vaccinationChlamydiaScreening 13 Antibioticsw/in 6hrs
11Ages 16-20 14 Oxygen assessment
12Ages 21-25 15 Smokingcessation
AdultRespiratoryTesting/Treatment 16 Antibioticselection
13Acutebronchitis 17 Bloodculture
MedicationManagement Surgical Infection
14Digoxinmonitoring 18 Antibioticreceived
Pedi: Testing/Treatment 19 Received appropriate preventiveantibiotic(s)
15Upperrespiratory infection (URI) 20 Antibioticdiscontinued
16Pharyngitis
Pedi: Well-visits
1715months
183-6 Years
19Adolescentwell-care visits
Outcomes / Diabetes 21 In-hospitalmortality - overall
20HbA1cin poor control 22 Wound infection
21LDL-C control (<100mg) 23 Select infections dueto medical care
22BloodPressurecontrol(130/80) 24 AMIaftermajor surgery
Hypertension 25 Pneumoniaaftermajor surgery
23Controllinghigh blood pressure 26 Post-OperativePE/DVT
CardiovascularDisease 27 BirthTrauma - injury to neonate
24LDL-C control (<100mg) 28 Obstetrics Trauma-vaginalw/oinstrument
PatientExperience / Patient Experiences (C/GCAHPS/ACES) - Hospital Patient Experience(H-CAHPS)
Adult 3 Measures
25Communication quality 29 Communication with nurses
26Knowledge ofpatients 30 Communication with doctors
27Integration ofcare 31 Responsivenessofstaff
28Access tocare 32 Discharge information
Patient Experiences (C/GCAHPS/ACES) -Pediatric 3
29Communication quality
30Knowledge ofpatients
31Integration ofcare
32Access tocare
BlueCrossBlueShieldofMassachusetts isan IndependentLicenseeoftheBlueCross andBlueShieldAssociation.

Note: For AQC contracts signed in 2009 and 2010, quality performance on these metrics could earn the organization a bonus of up to an additional 10% of its global budgeted amount. For AQC contracts signed beginning in 2011, organizations were eligible for quality bonuses on the same measure set, but with somewhat lesser total amounts available and bonuses defined as a per member per month amount rather than a percent of budget.

Appendix B: Probability of Tobacco Cessation Treatment Use with and without the Alternative Quality Contract (AQC), 2006-2011: Effects by Year of Implementation for the Overall Population

With AQC / Without AQC / Difference / P-value / [95% Conf. Interval]
Probability of any tobacco cessation treatment use (%)
AQC exposure - 1 year / 1.95% / 1.86% / 0.09% / 0.02 / 0.01 to 0.15
AQC exposure - 2 years / 2.10% / 1.86% / 0.24% / < 0.001* / 0.14 to 0.31
AQC exposure - 3 years / 2.10% / 1.86% / 0.24% / < 0.001* / 0.12 to 0.33
Probability of varenicline or bupropion use (%)
AQC exposure - 1 year / 1.57% / 1.51% / 0.06% / 0.08 / -.01 to 0.12
AQC exposure - 2 years / 1.65% / 1.51% / 0.14% / 0.001* / 0.05 to 0.21
AQC exposure - 3 years / 1.67% / 1.51% / 0.16% / 0.003* / 0.05 to 0.26
Probability of nicotine replacement therapy use (%)
AQC exposure - 1 year / 0.14% / 0.15% / -0.01% / 0.15 / -0.04 to 0.01
AQC exposure - 2 years / 0.15% / 0.15% / 0 / 0.61 / -0.03 to 0.02
AQC exposure - 3 years / 0.16% / 0.15% / 0.01% / 0.95 / -0.03 to 0.03
Probability of tobacco cessation counseling visit use (%)
AQC exposure - 1 year / 0.39% / 0.33% / 0.06% / < 0.001 / 0.04 to 0.09
AQC exposure - 2 years / 0.49% / 0.33% / 0.16% / < 0.001 / 0.11 to 0.17
AQC exposure - 3 years / 0.50% / 0.33% / 0.17% / < 0.001 / 0.11 to 0.19
Probability of combination therapy use (%)
AQC exposure - 1 year / 0.12% / 0.10% / 0.02% / 0.03 / 0.001 to 0.03
AQC exposure - 2 years / 0.14% / 0.09% 0.10% / 0.04% / < 0.001* / 0.02 to 0.06
AQC exposure - 3 years / 0.14% / 0.09% 0.10% / 0.04% / 0.001* / 0.01 to 0.06
Probability of 90 day supply of tobacco cessation pharmacotherapy, among pharmacotherapy users (%)
AQC exposure - 1 year / 10.25% / 10.11% / 0.03% / 0.83 / -1.08 to 1.35
AQC exposure - 2 years / 11.20% / 10.11% / 1.09% / 0.15 / -0.38 to 2.46
AQC exposure - 3 years / 9.54% / 10.11% / -0.57% / 0.52 / -2.39 to 1.21
Probability of > 1 counseling visit, among counseling visit users (%)
AQC exposure - 1 year / 21.55% / 19.77% / 1.78% / 0.29 / -1.50 to 5.02
AQC exposure - 2 years / 21.26% / 19.77% / 1.49% / 0.45 / -2.38 to 5.33
AQC exposure - 3 years / 24.50% / 19.77% / 4.73% / 0.06* / -0.20 to 9.11

* Effect size larger than Year 1 effect.

Appendix C: Probability of Tobacco Cessation Treatment Use with and without the Alternative Quality Contract (AQC), 2006-2011: Effects by Year of Implementation for the Population at Risk for Smoking-related Complications

With AQC / Without AQC / Difference / P-value / [95% Conf. Interval]
Probability of any tobacco cessation treatment use (%)
AQC exposure - 1 year / 4.80% / 4.66% / 0.14% / 0.40 / -0.19 to 0.48
AQC exposure - 2 years / 5.16% / 4.66% / 0.50% / 0.02 / 0.09 to 0.88
AQC exposure - 3 years / 5.18% / 4.66% / 0.52% / 0.05 / 0.01 to 1.00
Probability of varenicline or bupropion use (%)
AQC exposure - 1 year / 3.75% / 3.67% / 0.08% / 0.65 / -0.24 to 0.38
AQC exposure - 2 years / 4.05% / 3.67% / 0.38% / 0.06* / -0.01 to 0.73
AQC exposure - 3 years / 3.81% / 3.70% / 0.11% / 0.57 / -0.34 to 0.61
Probability of nicotine replacement therapy use (%)
AQC exposure - 1 year / 0.46% / 0.52% / -0.06% / 0.28 / -0.18 to 0.05
AQC exposure - 2 years / 0.49% / 0.52% / -0.03% / 0.67 / -0.16 to 0.10
AQC exposure - 3 years / 0.46% / 0.52% / -0.06% / 0.46 / -0.23 to 0.11
Probability of tobacco cessation counseling visit use (%)
AQC exposure - 1 year / 1.06% / 0.85% / 0.21% / 0.003 / 0.07 to 0.35
AQC exposure - 2 years / 1.28% / 0.85% / 0.43% / <.001* / 0.22 to 0.54
AQC exposure - 3 years / 1.52% / 0.85% / 0.67% / <.001* / 0.34 to 0.73
Probability of combination therapy use (%)
AQC exposure - 1 year / 0.37% / 0.28% / 0.09% / 0.03 / 0.01 to 0.17
AQC exposure - 2 years / 0.42% / 0.28% / 0.14% / 0.01* / 0.03 to 0.22
AQC exposure - 3 years / 0.45% / 0.28% / 0.17% / 0.02 / 0.03 to 0.26
Probability of 90 day supply of tobacco cessation pharmacotherapy, among pharmacotherapy users (%)
AQC exposure - 1 year / 11.45% / 12.75% / -1.30% / 0.32 / -3.98 to 1.29
AQC exposure - 2 years / 13.45% / 12.75% / 0.70% / 0.65 / -2.26 to 3.62
AQC exposure - 3 years / 10.01% / 12.75% / -2.74% / 0.13 / -6.74 to 0.90
Probability of > 1 counseling visit, among counseling visit users (%)
AQC exposure - 1 year / 27.34% / 27.46% / -4.12% / 0.97 / -6.63 to 6.63
AQC exposure - 2 years / 28.71% / 27.46% / 1.25% / 0.76 / -6.74 to 9.24
AQC exposure - 3 years / 33.91% / 27.46% / 6.45% / 0.22 / -3.58 to 15.86

* Effect size larger than Year 1 effect.

Appendix D: Probability of Tobacco Cessation Treatment Use with and without the Alternative Quality Contract (AQC), 2006-2011: Effects by Year of Implementation for the Behavioral Health Service Users

With AQC / Without AQC / Difference / P-value / [95% Conf. Interval]
Probability of any tobacco cessation treatment use (%)
AQC exposure - 1 year / 3.56% / 3.24% / 0.32% / 0.01 / 0.01 to 0.54
AQC exposure - 2 years / 3.82% / 3.24% / 0.58% / < 0.001* / 0.27 to 0.81
AQC exposure - 3 years / 3.76% / 3.24% / 0.52% / 0.003 / 0.16 to 0.83
Probability of varenicline or bupropion use (%)
AQC exposure - 1 year / 2.70% / 2.49% / 0.21% / 0.06 / -0.01 to 0.41
AQC exposure - 2 years / 2.85% / 2.49% / 0.36% / 0.01* / 0.09 to 0.59
AQC exposure - 3 years / 2.86% / 2.49% / 0.37% / 0.03* / 0.03 to 0.67
Probability of nicotine replacement therapy use (%)
AQC exposure - 1 year / 0.35% / 0.33% / 0.02% / 0.51 / -0.05 to 0.10
AQC exposure - 1 year / 0.31% / 0.33% / -0.02% / 0.63 / -0.12 to 0.07
AQC exposure - 1 year / 0.34% / 0.33% / 0.01% / 0.77 / -0.09 to 0.12
Probability of tobacco cessation counseling visit use (%)
AQC exposure - 1 year / 0.61% / 0.49% / 0.12% / 0.02 / 0.02 to 0.20
AQC exposure - 2 years / 0.83% / 0.49% / 0.34% / < 0.001* / 0.18 to 0.38
AQC exposure - 3 years / 0.81% / 0.49% / 0.32% / < 0.001* / 0.14 to 0.39
Probability of combination therapy use (%)
AQC exposure - 1 year / 0.24% / 0.17% / 0.07% / 0.02 / 0.01 to 0.12
AQC exposure - 2 years / 0.35% / 0.17% / 0.18% / < 0.001* / 0.08 to 0.20
AQC exposure - 3 years / 0.36% / 0.17% / 0.19% / <0.001* / 0.06 to 0.22
Probability of 90 day supply of tobacco cessation pharmacotherapy, among pharmacotherapy users (%)
AQC exposure - 1 year / 16.12% / 17.38% / -1.26% / 0.37 / -4.11 to 1.53
AQC exposure - 2 years / 18.41% / 17.38% / 1.03% / 0.54 / -2.23 to 4.25
AQC exposure - 3 years / 16.74% / 17.38% / -0.64% / 0.76 / -4.79 to 3.49
Probability of > 1 counseling visit, among counseling visit users (%)
AQC exposure - 1 year / 23.18% / 22.64% / 0.54% / 0.88 / -6.7 to 7.75
AQC exposure - 2 years / 24.88% / 22.64% / 2.24% / 0.59 / -5.88 to 10.27
AQC exposure - 3 years / 25.60% / 22.64% / 2.96% / 0.57 / -6.99 to 12.75

* Effect size larger than Year 1 effect