Cigna is seeing benefits from its variety of accountable care in obstetrics and gynecology, and is on track to expand the model.
New results from Cigna's collaborative care contracts with ob-gyn practices in Florida and Texas are showing promise in metrics like prevention of premature and cesarean deliveries.
The insurer set up incentive-based contracts with Women's Care Florida, a 200-provider practice serving greater Orlando and Tampa, and the Southwest Women's Health Alliance, a network of 52 providers in metropolitan Houston.
The goals of the program include reducing primary c-section deliveries and non-medically necessary inductions of labor prior to 39 weeks gestation, increasing generic prescribing and shifting gynecologic surgical procedures to less-costly sites. Cigna's health plans help the providers identify at-risk pregnant women and opportunities in maternal mental health, while compensating the practices based on their outcomes and costs compared to regional market peers.
After a year, Women's Care Florida reduced c-section deliveries by 15 percent, brough its rate for early elective deliveries to 3.7 percent (below the national rate of five percent), and improved generic drug dispensing by 6 percent. "Properly aligned incentives help us focus on what is needed to fulfill our mission," said Donald Wilson, MD, chief medical officer for Women's Care Florida. "We value meaningful partnership with health plans as we all seek to deliver high quality care in the most efficient manner possible."
It's not entirely clear how Southwest Women's Health Alliance performed on the primary endpoints of reduced c-sections and early elective births, but Cigna said the practice reduced total medical costs by three percent, improved generic dispensing by 7 percent and increased its use of office-based outpatient surgical procedures by 9 percent.
"We sought to improve patient satisfaction scores, implement new patient safety programs, improve the quality of our care by following evidence-based medicine and lead our market in quality metrics,"
said Mark Cone, MD, president of Southwest Women's Health Alliance. "We proved we could accomplish that and bend the total medical cost curve. Joint efforts between providers and payers like this demonstrate the type of collaborative efforts we will need to fix the healthcare delivery system."
Cigna has pilot programs with four other ob-gyn groups and is set to launch as many as six more this year. After a year of the pilots, the insurer said it will evaluate them and consider whether or how to transition from "test and learn" to standard contract models.
While other clinical areas are major targets of value-based contracts (Cigna is also launching an oncology collaborative care arrangement in New Jersey), obstetrics and gynecology may an especially ripe speciality for insurers to focus on. The rate of caesarean section births in the U.S. was 32.7 percent in 2013, more than double the World Health Organization's recommended "medically necessary" threshold of 15 percent for a national population.
"The Cigna Collaborative Care model demonstrated our ability to help large primary care physician groups improve the quality and cost of care," said John Keats, MD, Cigna medical director and a practicing ob-gyn in Southern California. "We're very pleased with their early successes and look forward to further collaboration that will help this model evolve."