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‘The actual fact that the quality of preventive and acute care improved beneath the AQC is definitely encouraging,’ Chien says. ‘Reducing costs likely requires more in-depth tracking, effort and experience.’.. Alternative Quality Contract model improves quality of care for sickest pediatric patients Within two years of implementation, Blue Cross Blue Shield of Massachusetts' Alternative Quality Agreement had a little but significant positive influence on the standard of pediatric care, according to a fresh study from Boston Kids's Hospital.