Sep 2 2009
CIGNA (NYSE:CI) and Medical Clinic of North Texas (MCNT) are preparing to launch a pilot program that incorporates components of the medical home model based on a comprehensive, accountable and collaborative approach they believe will lead to improved patient access, better continuity and coordination of care, improved quality of care for patients, and lower medical costs.
The pilot program, which begins today, will be the first commercially sponsored medical home type program in Texas that involves a multi-site medical practice and a single private payer. CIGNA will provide upfront funding to establish a process of care coordination led by a registered nurse working with a team of professionals that’s supported by MCNT and CIGNA data and clinical tools. The program is focused on individuals who receive care from MCNT’s primary care physicians who practice family medicine, internal medicine and pediatrics. Currently, more than 10,000 individuals covered by a CIGNA health plan can receive care from MCNT primary care physicians.
In a patient-centered medical home model of care, a primary care physician is responsible for monitoring and coordinating all aspects of an individual’s medical care. In the Texas pilot program, patients - especially those with chronic illness or ongoing medical needs - will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system.
Individuals will simply access care from one of the 82 MCNT primary care physicians participating in the pilot program. There is no change in choice of primary care doctor or in any plan requirements regarding referrals to see specialists.
"The goal of a patient-centered medical home is to improve quality and lower medical costs by expanding access and improving care coordination,” said Dr. Richard Johnston, president of MCNT. “As primary care physicians, it is our responsibility to work closely with our patients to assist them in maintaining healthy lifestyles, as well as to help those with chronic conditions manage their illnesses. With our fully implemented electronic medical records, comprehensive patient care coordination and high quality care standards, the Medical Clinic of North Texas believes that using the medical home model will significantly improve the overall health of our patients.”
“While there is much to be praised in our health care system, there are many aspects that can be improved through a patient-centered medical home model of care,” said Dr. Ken Phenow, CIGNA's senior medical director for North Texas. “Today’s health care system is too complex and fragmented, and the traditional physician payment structure de-emphasizes primary care by rewarding specialization and paying doctors to perform more procedures rather than delivering better outcomes and providing greater value to their patients. The patient-centered medical home concept is a promising approach for changing these dynamics, and we are pleased to be working with MCNT, which is deeply committed to the medical home model.”
Primary care physicians affiliated with MCNT will be paid as usual for the medical services they provide and may also be rewarded through a “pay for performance” structure for improving quality and enhancing access to appropriate health care. According to CIGNA's Phenow, emphasizing the value of the primary care physician as the overall coordinator of their patients’ health will help increase the professional satisfaction and financial rewards for doctors who practice in primary care.
According to Mark McClellan, M.D., Ph.D., director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, D.C., and former administrator of the Center for Medicare & Medicaid Services, this effort is compatible with similar payment and delivery system reforms being promoted nationally as part of health care reform. “It is critical that we get on a path toward paying more for health care that is better coordinated and leads to fewer complications and improved results – at a lower overall cost,” McClellan said.
A report recently developed by the Engelberg Center in conjunction with the Bipartisan Policy Center also notes that medical homes and related reforms hold promise for improving the delivery of care if they are: 1) effectively targeted to patient populations most likely to gain from more coordinated care; and 2) tied to specific steps to ensure greater physician and patient accountability for demonstrating better results.
CIGNA's pilot program with MCNT will be an ongoing initiative that will include an evaluation of results after the program has been operational for at least 12 months, and it’s intended to help CIGNA gather additional data about the effectiveness of this model in improving access to and quality of care, improving patient satisfaction and reducing medical costs.
CIGNA already participates in several medical home initiatives throughout the country, including multi-payer pilots in Colorado, Pennsylvania, and Vermont, and a CIGNA-only pilot in New Hampshire. CIGNA has been a member of the Patient-Centered Primary Care Collaborative since October 2007.