Cigna and Granite Healthcare Network, comprising five independent charitable healthcare organizations, have announced the formation of what the two organizations are calling the largest accountable care organization (ACO) in New Hampshire.
In all, the program seeks to serve and benefit more than 23,000 Cigna members in the state who will receive their healthcare from the more than 900 healthcare professionals who are part of the Granite Healthcare Network (GHN).
"Cigna has been a leader in accountable care, both here in New Hampshire and throughout the country, which is why we chose Cigna as the health plan for this initiative," said Greg Baxter, MD, chief medical officer for GHN, in a press release. "We believe that this arrangement with Cigna offers the best opportunity for us to improve healthcare quality, lower medical costs and help our patients lead healthier and more productive lives."
[See also: CIGNA says ACO pilots show lower costs, better quality of care; 10 things to know about ACOs]
Called collaborative accountable care by Cigna, its patient-centered approach seeks to both improve access to healthcare for its members while also greatly improving the coordination of care. Those most likely to benefit from the new accountable care structure with GCN are those with chronic conditions such as diabetes and heart disease.
At the heart of the program will be registered nurses working at all five GHN facilities as clinical care coordinators. The care coordinators will serve an integral role within the care delivery continuum helping patients to better manage the healthcare system, as well as manage chronic conditions. Cigna will also provide the care coordinators with patient-specific data that will aid the care coordinators in identifying gaps in care for recommended screenings and tests; identifying patients at the time of hospital discharge who may be at risk for readmission; and monitoring prescription fill data to help determine whether patients are taking their medications.
In short, the care coordinators will serve as direct contacts for patients to help them stay compliant with their care regimen, help them navigate the system and serve as a broad resource for all of their healthcare needs.
"The five Granite Healthcare Network organizations share our vision for a patient-centered healthcare system that emphasizes prevention and primary care and rewards physicians for care quality and health outcomes," said Donald Curry, president for Cigna in New England, in a prepared statement. "We believe that a system that's focused on value rather than volume of care offers the best path to improved health and lower medical costs, which is good for individuals, families, employers and doctors."
Granite Healthcare Network's five members are each independent health systems that consist of primary care doctors, specialists and hospitals. Its members are Concord Hospital in Concord; Elliot Health System in Manchester; LRGHealthcare in Laconia; Southern New Hampshire Health System in Nashua; and Wentworth-Douglass Hospital in Dover.
Under the terms of the new contract, Cigna will use a blended payment model for the accountable care structure: GHN members will receive payment for the medical and care coordination services it provides to Cigna members, and will also be eligible for pay-for-performance bonuses based on meeting or exceeding targets for improving the quality of care and lowering medical costs.