Cigna (NYSE: CI) has been at the forefront of the accountable care
organization movement since 2008 when it launched its first
patient-centered initiative in New Hampshire. Building on the company’s
success with that
early initiative and others like it in Arizona, Texas and other
states, the company in 2012 set an ambitious goal to have 100 Cigna
Collaborative Care arrangements with large physician groups in 2014
that would reach one million customers. Last week, Cigna achieved that
goal with the addition of 11 arrangements in seven states.
“We’re thrilled that we’ve reached the milestone of 100 Cigna
Collaborative Care arrangements with some of the most forward-thinking
large physician groups in the country,” said Alan M. Muney, M.D.,
Cigna's chief medical officer. “The leaders of these organizations are
fully committed to collaborating with us and recognize the value of
delivering better health, affordability, and experience.”
Results
In places where it’s been introduced, Cigna Collaborative Care is helping
to improve the health of Cigna customers while holding the line on
medical costs. The programs are helping to close gaps in care, such
as missed health screenings or prescription refills, reducing
unnecessary use of hospital emergency rooms, increasing the number of
preventive health visits and improving follow-up care for people
transitioning from the hospital to home.
Among the arrangements that have been operational for two or more
years:
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73 percent have met targets for improving quality
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73 percent have met targets for controlling total medical cost
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55 percent have met targets for both quality and total medical cost.
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On average, these arrangements have demonstrated 3 percent better than
market average total medical cost and 2 percent better than market
average quality.
Among arrangements that have been operational for at least one year:
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63 percent have met targets for improving quality
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50 percent have met targets for controlling total medical cost
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37 percent have met targets for both quality and total medical cost
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On average, these arrangements have been at par with market average
total medical cost and 2 percent better than market average quality.
“These results,
especially the strong performance by our most mature arrangements, show
what’s possible through sustained collaboration over time,” Muney noted.
“In order to have achieved substantial impacts on quality and
affordability, these medical groups have implemented best practices
across their physician and clinical support teams to use the new
information and resources from Cigna that are available to help them. We
think we’re working with the right organizations that have what it takes
to be successful.”
Six Keys to Success
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Sharing useful patient information: Cigna has claims data with
information about individuals that physicians often don’t have; for
example, listings of patients who have been admitted to the emergency
room, or patients who have been treated by a Cigna network doctor in
another state. Sharing this information with the collaborative care
doctors enables them to have a more complete picture of their
patients’ health and helps identify which of their patients might
require outreach and follow-up care.
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Cigna's predictive modeling capabilities: Predictive modeling
helps identify patients who are being discharged from the hospital who
might be at high risk for readmission. Identifying these patients
presents an opportunity to develop a post-discharge care plan that
could include home care and outreach from the collaborative care
doctor’s office.
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Embedded care coordinators: Typically a nurse who is employed
by the collaborative care physician group, the care coordinator helps
patients with chronic conditions or other health challenges navigate
the health care system. Care coordinators use Cigna's patient-specific
data to see who is being discharged from the hospital, who may be
overdue for important health screenings or who may have skipped a
prescription refill. They help patients get the follow-up care or
screenings they need, identify potential complications related to
medications and help prevent chronic conditions from worsening. They
also help patients schedule appointments, provide health education and
refer patients to Cigna's clinical support programs that help
individuals manage diabetes, heart disease and other chronic
conditions, or help with tobacco cessation, weight management or
stress management.
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Communication and collaboration: Cigna clinical staff,
including medical executives and nurse clinicians, meets frequently
with physician group management and patient care teams to explain
optimal use of Cigna's patient-specific information to improve patient
health. The Cigna team makes recommendations to improve program
management, planning and execution, and identifies key actions that
care coordinators should focus on.
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Clinical integration: Cigna's case managers are aligned to
specific collaborative care physician groups and develop strong
working relationships with the care coordinators. This ensures that
the physician group has easy access to the breadth of Cigna tools and
services, such as case management and chronic condition management, to
complement the patient-facing care that the physician group provides.
This leverages resources of both organizations to help Cigna customers
get the care they need when and where they need it.
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Aligning incentives to performance: Cigna Collaborative Care
physician groups earn additional “pay for value” reimbursement when
they achieve targets for both quality and affordability.
Effective July 1, the newest members of Cigna's network of
collaborative care arrangements are:
In Connecticut: Northeast Medical Group (NEMG), a physician group
affiliated with Yale New Haven Health in New Haven. http://yalenewhavenhealth.org/nemg/
In Georgia: Harbin Clinic, a multi-specialty medical practice in
Rome. http://harbinclinic.com/
In Georgia: Physician Performance Network of Georgia/Tenet, a
clinical integration organization among Tenet Healthcare’s Atlanta area
physicians. http://www.ppnga.com/
In Illinois: Presence Health Partners, a physician-led network of
health care providers affiliated with Presence Health, the largest
Catholic integrated health system based in Illinois. http://www.presencehealth.org/
In New Jersey: Skylands Medical Group, an independent, primary
care-based multi-specialty medical group in Newton. http://www.skylandsmedicalgroup.com/
In Tennessee: Primary Care Partners LLC, an independent,
physician-led network of primary care providers serving patients in the
Tri-Cities region, including Kingsport, Johnson City and southwest
Virginia. www.sofha.net
and www.mrfm.net
In Tennessee: Wellmont Medical Associates, a physician-led
medical practice affiliated with Wellmont Health System in Kingsport. http://www.wellmont.org
In Texas: The Austin Diagnostic Clinic, an
independent, physician-led multi-specialty clinic in Austin. http://www.adclinic.com/
In Texas: St. Joseph Health Partners, a physician practice
affiliated with St. Joseph Health System in Bryan/College Station. http://www.st-joseph.org/
In Texas: Village Family Practice, a family medical
practice in Houston. https://www.villagefamilypractice.com/
In Washington: EvergreenHealth Partners, a clinically integrated
network of more than 500 physicians and health care professionals
affiliated with EvergreenHealth in Kirkland. www.evergreenhealth.com
The 100 Cigna
Collaborative Care arrangements with large physician groups span 27
states, reach more than one million commercial customers and encompass
more than 39,000 doctors, including more than 19,000 primary care
physicians and more than 20,000 specialists.
Cigna Collaborative Care is one component of the company's approach to
physician engagement for health improvement, which also includes the
innovative Cigna-HealthSpring® care model for Medicare customers. Today,
more than 1.3 million Cigna and Cigna-HealthSpring customers benefit
from 265 engaged physician relationships across 31 states, with more
than 66,000 doctors participating, including more than 25,000 primary
care physicians and more than 41,000 specialists.
About Cigna
Cigna Corporation (NYSE: CI) is a global health service company
dedicated to helping people improve their health, well-being and sense
of security. All products and services are provided exclusively by or
through operating subsidiaries of Cigna Corporation, including
Connecticut General Life Insurance Company, Cigna Health and Life
Insurance Company, Life Insurance Company of North America and Cigna
Life Insurance Company of New York. Such products and services include
an integrated suite of health services, such as medical, dental,
behavioral health, pharmacy, vision, supplemental benefits, and other
related products including group life, accident and disability
insurance. Cigna maintains sales capability in 30 countries and
jurisdictions, and has more than 80 million customer relationships
throughout the world. To learn more about Cigna®, including links to
follow us on Facebook or Twitter, visit www.cigna.com.
Copyright Business Wire 2014