From volume to value

Tuesday, May 07, 2013 01:15 PM
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Cigna’s Collaborative Accountable Care program transforming physician groups across the country

Mark Slitt, Communications Manager, Cigna

In 2008, well before “Obamacare,” global health service company Cigna embarked on a journey to transform the U.S. health care delivery system from one that paid for volume to one that pays for value.

Cigna’s Collaborative Accountable Care (CAC) program started as a single pilot program in New Hampshire with Dartmouth-Hitchcock based on the principles of the patient-centered medical home. Since then, the CAC program has grown to involve nearly 60 physician groups in 24 states – including four groups in Colorado - reaching more than 650,000 Cigna customers throughout the U.S. who receive primary and specialty care from more than 23,000 participating doctors.

The four Colorado physician practices currently participating in CAC are Colorado Springs Health Partners, Integrated Physician Network (iPN), Med-South and New West Physicians. Cigna continues to look for additional medical groups that would be good candidates to join the program.

CAC is Cigna’s approach to accountable care organizations, or ACOs. The CAC program shares the same population health goals as ACOs – the “triple aim” of better quality, affordability and patient satisfaction.

“What sets Cigna’s program apart from other accountable care programs is the high degree of coordination and collaboration between Cigna and the physician groups, which is why we call it collaborative accountable care,” said Mark Laitos, MD, Cigna’s medical executive for Colorado.

Cigna shares patient-specific data that physicians can use to improve care, such as lists of hospitalized patients who might be at risk for readmission; diabetic patients who may be overdue for an A1c; or patients who may have skipped a prescription refill.

“Our claims data contain information that can help the physician groups identify which patients are not coming to their office but might need follow-up care or outreach, information doctors can’t get through the patient’s chart,” Dr. Laitos said.

Care coordinators employed by the practices and supported by Cigna – typically registered nurses – 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.

Cigna also helps physician groups identify practice-specific issues, such as high emergency room use or an above-average rate of referrals to higher-cost specialists.

Another important aspect of the program is clinical coordination between the physician groups and Cigna. Care coordinators work in the physician’s office and use tools that work best in that office to help their doctors reach out to patients missing opportunities for care. They can also augment doctors’ instructions by referring patients to Cigna’s chronic condition and lifestyle management programs if appropriate.

Integrated Physician Network is pleased to participate in CIGNA’s CAC program as an important step toward value-based payment reform,” said David Ehrenberger, MD, chief medical officer of Avista Adventist Hospital and Integrated Physician Network. “For eight years, our 200 providers have worked successfully to drive superior quality outcomes for our patient populations. The CIGNA CAC initiative helps support our care coordination services and strengthens our population health services. Beyond better health and health care, this innovative program helps us complete the third goal of the triple aim: superior quality at lower cost.”

“Our goal is to align incentives for doctors to expand access to care and clinical support programs, so that Cigna customers get the right care and support at the right place at the right time,” Dr. Laitos said. “We aim to improve quality, which means better health for Cigna customers and lower total medical costs. When a CAC physician group meets its annual targets for improving quality and lowering cost, they’re rewarded through shared savings. Aligning physician incentives to results is key.”

Early returns on investment
But does it work? Results from some early adopters indicate that it does. For example, in 2011 Medical Clinic of North Texas improved total medical cost trend by 4.4 percent while maintaining quality (as measured by following evidence-based medical guidelines) at 4 percent better than the Dallas/Fort Worth market. During the same period, 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 24 percent lower than the Phoenix market.

While it’s still too early to measure results for the Colorado CACs (as none of them have been in place for a full year), Dr. Laitos said Cigna expects them to perform well.

“The physician groups we’re working with in Colorado all have a strong patient-centered culture and a firm commitment to achieving the Triple Aim,” Dr. Laitos said. “We expect they will be able to achieve results similar to what we’ve seen in other successful practices, such as reduced emergency room use, better medical cost trend and improved health for patients with chronic conditions.” While Collaborative Accountable Care continues to grow, it’s not the only approach that Cigna is taking in an effort to move from volume to value. “Not all Cigna customers go to a doctor who is part of a large practice,” Dr. Laitos noted, “so we’re developing other programs targeted to small and solo practices.”

Cigna is participating in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care program. “Cigna supports this program for our fully insured clients, when Cigna’s dollars are at risk. With our self-insured clients, it’s their own dollars that are at risk, so we let the client make the decision to participate,” Dr. Laitos said.

Posted in: Colorado Medicine | Practice Evolution | Payment Reform | Interacting With Payers | Practice Redesign | Accountable Care Organizations


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