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Connecticut Medical Practices Collaborating With Cigna are Having Success Improving Quality and Lowering Medical Costs

CI | May 20, 2015

Medical practices in Connecticut that participate in the Cigna (NYSE: CI) Collaborative Care initiative are having success improving quality and lowering medical costs, which is what the program was designed to do. Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs: improved health, affordability and patient experience.

“When gaps in care are closed, when doctors follow evidence-based medicine guidelines, when individuals get care in the proper setting rather than the emergency room, the quality of care goes up, people are healthier, they have a better experience and costs are reined in,” said Robert Hockmuth, M.D., senior medical director for Cigna in Connecticut. “That’s really what Cigna Collaborative Care is all about, and these medical groups are excellent examples of how well it’s working.”

Farmington-based ProHealth Physicians was among the first medical groups to participate in Cigna Collaborative Care. When the group started collaborating with Cigna in October 2009, it was the first program of its kind in Connecticut to focus on enhanced care coordination and physician pay-for-value for meeting targets for quality and cost improvements.

ProHealth has focused strongly on reducing unnecessary emergency room use (ER visits for non-emergency care), and as a result, its emergency room use is 7 percent lower than market. ProHealth accomplished this significant improvement mainly by opening urgent care clinics in areas where people with high ER use lived, making it easier for them to get the right care at the right time in the right setting.

Another area of success for ProHealth has been closing gaps in care for chronic conditions. (Gaps in care refer to overdue screenings or lack of follow-up care for certain medical conditions, as well as missed prescription refills.) For example, ProHealth outperforms the market by 9 percent on diabetes measures, which means its diabetic patients are receiving testing and treatment according to the recommended guidelines. That helps these individuals avoid medical complications and potential higher cost care in the future.

The price of advanced imaging, such as CT scans, can vary considerably by location, which is a strong driver of medical costs. ProHealth’s 37 percent referral rate to preferred providers of CT scans and MRI outperforms the market, and by focusing on evidence-based guidelines, its use of advanced imaging is 16 percent better than market.

“ProHealth is pleased to be among the first participants in Cigna Collaborative Care,” said Jim Cox-Chapman, M.D., chief medical officer for ProHealth. “We have enjoyed the opportunity to work with our payer partners to improve the health care experience for our shared population. Cigna was among the first health plans in our state to recognize the value of such collaboration, and we are delighted to have consistently demonstrated our success in both quality improvement and managing health care expenses.”

Community Medical Group is an integrated network of physicians and other health care professionals that has participated in Cigna Collaborative Care since October 2012. The group’s total medical cost is trending 1.9 percent better than market and its success rate with evidence-based medicine guidelines is better than market at 85.3 percent.

The group has a strong focus on reducing avoidable emergency room use. By encouraging its patients to use its primary care providers and urgent care centers that participate in Cigna's network, avoidable ER visits per thousand have decreased by 23 percent, while overall ER visits decreased 10 percent, and ER visits by individuals considered to be “frequent users” decreased by 12 percent.

Community Medical Group’s use of scans per thousand is trending 12 percent better than market and its advanced imaging cost has decreased 14 percent due to increased patient referrals to preferred providers who offer quality imaging at a lower cost.

The group has put a strong focus on following evidence-based medicine guidelines and has had its best success with diabetes: 96 percent of its diabetes patients have the HbA1c (blood sugar) test. The group has also had success closing gaps in care, in particular for treatment of high cholesterol at 2 percent better than market and epilepsy at 15 percent better than market.

Community Medical Group also implemented an initiative to improve treatment with injectable specialty medications. One of its patients needed intravenously administered immunoglobulin (IVIG) and the group helped redirect the hospital-based treatment to home-based care. By having the treatment at home, the individual did not have to miss work days and saved $400,000 in medical costs.

“We joined the Cigna Collaborative Care initiative because we saw it as an opportunity to improve the quality of our care as well as an opportunity to help make health care more affordable,” said Joseph Quaranta, M.D., president, Community Medical Group. “These successes show that we’re moving in the right direction.”

Putnam-based Day Kimball Healthcare and its affiliated physicians group is an integrated medical services network serving northeast Connecticut that has participated in Cigna Collaborative Care since October 2012. The group is showing solid improvements in both quality and cost, with improved breast cancer screening, diabetes care and cervical screening driving quality results. Its rate for closing gaps in care improved 7 percent last year compared to the year before.

In addition, overall emergency room use is down and is trending 3.4 percent better than market while avoidable emergency room visits (visits for non-emergency care) are down 9 percent year over year. The group’s medical cost trend is beating the Connecticut market by 4.2 percent.

Much of Day Kimball’s success can be attributed to the care coordinators - registered nurses employed by the medical group who help individuals navigate the health care system, help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

For example, when Cigna customers are hospitalized at Day Kimball Hospital, the care coordinator visits them at their bedside for an initial transition of care discussion, and then reaches out within two business days after discharge. The care coordinator identifies individuals who could benefit from Cigna clinical programs, such as stress or weight management, or chronic condition management for diabetes, and coordinates with Cigna to enroll individuals in those programs. The care coordinator also identifies individuals who have a high health risk score and collaborates with an aligned Cigna case manager to discuss the most appropriate plan of care.

“I can’t emphasize enough how important the care coordinator is to the success of this program,” said John N. Graham, M.D., chief medical officer for Day Kimball. “The care coordinator is an essential member of the clinical team who follows up with our patients and makes sure they get connected to the resources they need to manage their health.”

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 88 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.

Community Medical Group

The Community Medical Group, Inc. is an integrated network of physicians, podiatrists, midlevel practitioners, and other licensed healthcare providers dedicated to providing the communities they serve with appropriate access to care, clinical services excellence and the prudent use of resources. Founded in 1987, Community Medical Group includes 750 providers in over 300 practices located throughout New Haven County and Fairfield County. Community Medical Group is a Connecticut corporation governed by an elected physician Board of Directors that is responsible for the governance and management of the organization.

About Day Kimball

Day Kimball Healthcare is a non-profit, integrated medical services provider comprised of Day Kimball Hospital, healthcare centers in Danielson, Dayville, Plainfield and Putnam, Day Kimball HomeCare, Hospice & Palliative Care of Northeastern CT, Day Kimball HomeMakers, and Day Kimball Medical Group. Its service area includes Northeast Connecticut as well as nearby Massachusetts and Rhode Island communities. Day Kimball Healthcare’s comprehensive network offers more than 1,400 employees including nearly 300 associated, highly-skilled physicians, surgeons and specialists. Its website is daykimball.org.

About ProHealth

Based in Farmington, CT, ProHealth Physicians is Connecticut’s largest physician-owned healthcare delivery system, operating 95 practices, serving over 380,000 active patients, and completing over 850,000 patient encounters per year. Formed in 1997, ProHealth has grown to include more than 350 primary care and specialty providers and offers select specialty and diagnostic/therapeutic services such as ENT, pediatric and adult gastroenterology, plastic surgery, imaging, physical therapy, sleep medicine services, ADHD diagnosis and treatment, audiology, neurology, and regional Express Care walk-in centers to meet patients’ needs for access and convenience. For the past 15 years, ProHealth’s clinical performance program has enabled its providers to identify patients who are due for specific healthcare screenings and tests based on the clinical guidelines relevant to the individual patient’s condition. ProHealth has participated in the Medicare Shared Savings Program since 2013 and is contracted to care for more than 100,000 patients through commercial shared savings agreements. ProHealth cares for over 10% of Connecticut’s population and continues to expand throughout the state.