Cigna (NYSE: CI) and Hunterdon Healthcare Partners, LLC, a physician hospital organization (PHO) affiliated with Hunterdon Healthcare, have launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination, and achieve the "triple aim" of improved health, affordability and patient experience. The program became effective July 1.
“We want to fundamentally change the health care delivery system by rewarding physicians for results”
Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program will benefit approximately 6,500 individuals covered by a Cigna health plan who receive care from Hunterdon Healthcare Partners' 120 primary care physicians and 280 specialists.
"In the past several years, the health care industry has changed with the demands of health care reform. The industry trend is shifting from paying for services, regardless of patient outcomes, to paying for care that delivers better value, quality and patient satisfaction. Collaborating with Cigna will help Hunterdon Healthcare deliver better care at a better price. We think patients will see direct benefit from this approach," explained Jeffrey Weinstein, executive director for Hunterdon Healthcare Partners. Weinstein added, "This not only supports our mission to deliver better access to primary care and specialist physicians, but will allow us to better provide integrated health care to improve the health of our community. Our collaboration with Cigna is an opportunity to achieve the 'triple aim' while delivering well-coordinated patient care that results in health improvement."
"We want to fundamentally change the health care delivery system by rewarding physicians for results," said Ron Menzin, M.D., Cigna's senior medical director for New Jersey. "A patient-centered system that's focused on prevention and wellness, combined with the right incentives for physicians, will ultimately result in a healthier population and lower medical costs. That's good for individuals, families, employers and doctors."
Under the program, Hunterdon Healthcare Partners monitors and coordinates all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.
Critical to the program's benefits are registered nurses, employed by Hunterdon Healthcare Partners, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the medical group and Cigna that ultimately results in a better experience for the individual.
The care coordinators will enhance care by using patient-specific data from Cigna to help identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators are part of the physician-led care team that helps patients get the follow-up care or screenings they need, identifies potential complications related to medications and helps prevent chronic conditions from worsening.
Care coordinators can also help patients schedule appointments, provide health education and refer patients to Cigna's clinical support programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.
Cigna will compensate Hunterdon Healthcare Partners for the medical and care coordination services it provides. Additionally, the medical group may be rewarded through a "pay for value" structure if it meets targets for improving quality and lowering medical costs.
The principles of the patient-centered medical home are the foundation of Cigna's collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with physician practices. Cigna has 66 collaborative accountable care initiatives in 26 states, encompassing more than 700,000 commercial customers and more than 27,000 doctors, including more than 12,500 primary care physicians and nearly 14,500 specialists. Cigna launched its first collaborative accountable care program in 2008 and its goal is to have 100 of them in place with one million customers in 2014.
Collaborative accountable care is one component of the company's approach to physician engagement for health improvement, which also includes Cigna-HealthSpring's care model for Medicare customers. Taken together, these 231 programs in 31 states reach more than one million customers and have nearly 55,000 participating doctors, including nearly 19,000 primary care physicians and nearly 36,000 specialists.