Physician groups in five states are poised to expand their participation in a Cigna-led accountable care program, with two additional states slated to newly join the collaborative, officials announced Oct. 18.
Groups in Nevada and Oregon are the latest members to sign on with the Cigna collaborative care program, with physician practices across Arizona, California, Colorado, Connecticut, Nevada, Oregon and Tennessee also pledging to the program. With the addition of these initiatives, the healthcare management company now includes 42 collaborative accountable care programs in 18 states and covers more than 390,000 customers. Cigna launched its first collaborative accountable care program in 2008.
These programs focus on expanding patient access to health care, improving care coordination, and achieving a triple aim of improved health outcomes, affordability and patient satisfaction. Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations (ACOs) with a strong focus on high-risk individuals.
In places where the initiative has been introduced, officials say collaborative accountable care is helping to improve the health of patients while holding the line on medical costs. The programs, officials add, are also helping to close gaps in care, such as missed health screenings or prescriptions refills, and they're reducing unnecessary use of hospital emergency rooms, increasing the number preventive health visits and improving follow-up care for people transitioning from the hospital to home.
In 2011, for example, officials at Medical Clinic of North Texas witnessed the total medical cost trend improve by 4.4 percent while maintaining at four percent better than the North Texas market. During the same period, Eastern Maine Healthcare Systems maintained quality at five percent better than its market. Additionally, in 2011, Holston Medical Group had an overall emergency room visit rate that was 12 percent lower than its Eastern Tennessee market, while avoidable emergency room visits for Cigna Medical Group were pegged at 24 percent below the Phoenix market.
The newest members of Cigna's network of collaborative accountable care initiatives are:
Banner Health Network (effective Nov. 1), a nonprofit health system with operations throughout the West, including greater Phoenix.
Brown & Toland Physicians, an independent practice association based in San Francisco.
The integrated Physician Network (iPN), a quality improvement collaborative that's affiliated with Colorado's largest not-for-profit health care system, Centura Health.
MedSouth, a multi-specialty, clinically integrated independent practice association located in the south metropolitan area of Denver.
Day Kimball Healthcare and its affiliated physicians group, an integrated medical services network serving northeast Connecticut.
New Haven Community Medical Group, an integrated network of physicians and other health care professionals that works in clinical collaboration with the Yale-New Haven Hospital.
HealthCare Partners, a network of primary care physicians and specialists with medical clinics and specialty care affiliates throughout greater Las Vegas.
Synergy HealthCare LLC, an independent physician association managed by Tennessee Quest (a HealthSpring physician management company), serving Nashville and middle Tennessee.
Legacy Health, a community-owned health system in greater Portland.
"Our collaborative accountable care programs continue to show improvements in quality and cost, to the benefit of our clients and customers, so we remain committed to our goal of 100 programs reaching one million individuals by the end of 2014," says Alan M. Muney, MD, Cigna's chief medical officer. "We're very selective when we choose the physician groups to be part of this effort. These physician groups are committed to putting the patient at the center of its practice, with expanded access to care, better coordination of care, patient education about chronic conditions and wellness, access to clinical programs for health improvement, and smart use of technology that improves the patient experience."
"Employers bear such a large part of the nation's health care costs, and they're always looking for ways to transform our health care system from one that rewards doctors for volume of care to one that rewards them for improving quality and value of care," says Helen Darling, president and chief executive officer of the National Business Group on Health. This collaborative, Darling adds, "is taking an important step in that direction."
Critical to the programs' benefits, officials say, are registered nurses, employed by the physician practices, as they are clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. Care coordinators from each physician practice are aligned to a team of case managers to ensure a high degree of collaboration between the medical group and Cigna that has been shown to result in a better experience for the individual.
The coordinators enhance care, officials add, by using patient-specific data to identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. Care coordinators contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.
Care coordinators also help patients schedule appointments, provide health education and refer patients to Cigna's clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.
Cigna will compensate physician groups for the medical and care coordination services they provide. The physician groups will also be rewarded through a "pay for performance" structure if they meet targets for improving quality and lowering medical costs.