Cigna and independent physicians organization Partners in Care, which operates in New Jersey, recently launched an accountable care organization that will treat more than 14,000 Cigna members at roughly 160 participating PIC practices.
Cigna's program with PIC is the first patient-centered accountable care program in Central and Northern New Jersey involving an independent physicians organization and a health plan. Its ultimate goal is to provide better service to both improve access to care and better coordinate care for Cigna members, with an eye on achieving the "triple aim" of increasing patient satisfaction, improving health outcomes and lowering the overall cost of care.
[See also: CIGNA says ACO pilots show lower costs, better quality of care; 10 things to know about ACOs .]
"Patients with chronic conditions, such as diabetes or hypertension, see many different specialists and healthcare professionals with little to no coordination among them. It is unnecessary, disorganized and dangerous," said Steven Goldberg, MD, chairman, PIC in a press release. "Monitoring these patients and ensuring their care givers are talking to one another – with one patient-selected personal physician in the leadership role – will undoubtedly lead to safer, more consistent and more effective medical care."
Under the program, patients will continue to go to their current physician, who will monitor and coordinate all aspects of that patient's care. An important feature of the program and one both organizations say is critical to its success are clinicians and registered nurses who will serve as care coordinators for the patients.
The role of the care coordinators will be to help those patients with chronic conditions or other health challenges better navigate the healthcare system in order to get the care they need, when they need it. The care coordinators will also have access to patient-specific data provided by Cigna that can help them identify patients who may be at risk after hospital discharge for costly re-admissions. Cigna data will also help flag those patients who may be overdue for a routine medical screening or procedure, along with those who may have skipped filling a prescribed medication – information which allows the care coordinator to proactively follow-up with the patient and optimize their care.
"The current healthcare system is focused on treating illness and rewards physicians for volume rather than value; it's not designed to drive long-term health improvement and lower costs," said Ron Menzin, MD, Cigna's medical director for New Jersey in a statement. "If our goal is a healthier population and lower medical costs, we need to create a patient-centered healthcare system that emphasizes prevention and primary care and that rewards physicians for quality of care and improved health outcomes."
Cigna will pay physicians as usual for the medical services they provide. Partners In Care will also pay the physicians for the care coordination services they provide on the patient's behalf. Additionally, physicians may be rewarded through a "pay-for-performance" structure if they meet targets for improving quality and lowering medical costs.
The program with PIC is similar to a number of other patient-centered collaborations Cigna has launched over the past few years. One of the more active payers in terms of creating payer-physician collaborations, Cigna is now currently involved in 17 patient-centered initiatives in 15 states, encompassing more than 170,000 Cigna customers and more than 1,800 primary care physicians. The company plans to continue increasing the number of initiatives significantly in 2012.