Cigna and the Piedmont Physicians Group, part of Atlanta-based Piedmont Healthcare, have launched an accountable care organization pilot program, designed to provide a comprehensive, accountable and collaborative approach to medical care.
"Piedmont physicians have been at the forefront of patient-centered care for over 100 years in Georgia," said James Sams, MD, the group's medical director. "The launch of this program is a natural progression for leading the charge for better patient outcomes."
According to officials of the Bloomfield, Conn.-based insurer, the program with Piedmont is the first ACO to operate in Georgia. The company expects that patients who need help monitoring and treating chronic conditions, such as diabetes, will see the most immediate benefits.
Cigna is looking to develop models and care structures that place emphasis on prevention, as well as a focusing on providing care that improves outcomes while reducing costs. Other programs include multi-payer pilots in Colorado, New Hampshire, Pennsylvania and Vermont, as well as CIGNA-only accountable care organization pilots in Connecticut, New Hampshire and Texas.
"At Cigna (we) have a dozen fully functioning pilots up and running with either medical homes, built around the physician practice, or accountable care organizations, built around hospitals," said Cigna CEO David Cordani. "We've essentially revisited the entire information flow and incentive process to pay based upon quality of outcomes vs. just activities."
The insurer's focus on seeking different models of healthcare that improve health and lower costs is not surprising, given that roughly 80 percent of its healthcare business is focused on providing service to large companies that have self-funded health benefits.
The newest program, which began July 1, is focused on approximately 10,000 individuals covered by a Cigna health plan who receive care from one of the Piedmont Group's more than 100 primary care physicians.
During the pilot, a group practice will monitor and coordinate the medical care of all patients covered by Cigna in the ACO.
"We believe that we can achieve better clinical outcomes by adopting a patient-centered model of primary care," said David Epstein, Cigna's senior medical director for Georgia. "Healthcare in the United States has shifted away from prevention and primary care, which has resulted in a 'disease care' system that relies more on specialist intervention and rescue procedures rather than improving health and providing greater value to patients. The patient-centered model places the focus back where it belongs – on improving the health of individuals through comprehensive primary care services and delivering better outcomes through enhanced care coordination."
Under the pilot, the Piedmont Physicians Group will be paid as usual for the medical services it provides, plus an additional fee for care coordination and other medical home services. Physicians will also be rewarded through a "pay for performance" structure if they meet targets for improving quality and lowering medical costs.