Joining its peers in touting accountable care, Cigna has met a fairly ambitious goal set two years ago, but more time is needed to test the strategy's sustainability.
With the start of 11 new ACO contracts in seven states this month, the company says it now has 100 "collaborative care" arrangements with large physician groups that reach one million members, and they're starting to pay off.
The 100 contracts/1 million members goal was set in 2012 and the initiative with large medical practices now spans 27 states and almost 40,000 primary care physicians and specialists. Including seniors on Cigna's HealthSpring Medicare Advantage plan, some 1.3 million of the insurer's 11-plus million members in 31 states are covered through either collaborative ACO contracts or "engaged physician relationships," said Cigna chief medical officer Alan Muney, MD.
Of the contracts in effect for at least two years, 73 percent have met quality care targets, 73 percent have met total medical cost targets and more than half have met both quality and cost goals. Among arrangements that have been operational for at least one year, 63 percent have met targets for improving quality, 50 percent have met targets for controlling total medical cost and 37 have met targets for both.
"These results, especially the strong performance by our most mature arrangements, show what's possible through sustained collaboration over time," said Muney, a pediatrician licensed in Connecticut and New York and a former medical officer at UnitedHealthcare and Oxford Health Plans. "In order to have achieved substantial impacts on quality and affordability, these medical groups have implemented best practices across their physician and clinical support teams."
Muney, who worked in private equity at the Blackstone Group before joining Cigna in 2010, argues that several factors have helped guide the collaborative care strategy.
For one, the insurer has made a point to share claims data from across providers with doctors in its collaborative care networks, including using predictive modeling for patients being discharged and recovering from hospitalizations.
It is also deploying case managers and care coordinators to work with physician groups to use data tools and help members navigate different parts of the healthcare system. Then there is "aligning incentives to performance," Muney said. Instead of fee-for-services, physician groups are paid on a per-member basis and can garner additional reimbursement "when they achieve targets for both quality and affordability."
Several years after large insurers started crafting accountable care strategies, Cigna is joining others in sharing initially promising results. Aetna recently publicized the results of a patient-centered medical home contract with an independent physician group in the New York City suburbs, including a 35 percent reduction in hospital admissions and fewer ER visits and hospital readmissions for a cohort of 5,650 patients.