Cigna, PAMF launch collaborative accountable care initiative

This patient-centered collaboration is Cigna's first accountable care initiative in California. It links doctors, hospitals and a single health plan together with the goal of reducing health care costs by improving patients' health.

The program will benefit as many as 21,000 individuals covered by a Cigna PPO health plan who receive care from PAMF's more than 1,000 primary and specialty care physicians, including those in its affiliated independent physician association, Mills-Peninsula Medical Group.

"Cigna is a national leader in accountable care, which is why we are enthusiastic about working with the company as part of this program," says PAMF Chief Executive Officer Richard Slavin, M.D. "We believe this arrangement offers a wonderful opportunity for us to improve health care quality, lower medical costs and help our patients lead healthier and more productive lives.

"PAMF is a pioneer in the adoption of electronic health record technology to coordinate care, reduce errors and improve communication between clinicians and patients. These technologically advanced capabilities make PAMF uniquely suited to a collaborative accountable care initiative," Dr. Slavin adds.

"It is critical that insurers and health care providers work more closely together to improve service to patients," says Cecilia Montalvo, regional vice president of strategy and business development at PAMF and the Peninsula Coastal Region of Sutter Health. "We believe that by partnering with Cigna, we are entering into the type of health plan-health care provider collaboration that will serve as a model for the future in rewarding innovation and quality of care."

Patients will continue to go to their current physician and will automatically receive the benefits of the program. There also 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, who serve as clinical care coordinators to help patients navigate their health care system. The care coordinators will reach out to patients who are overdue for important health screenings or who may have skipped a prescription refill. In addition, patients who may be at increased risk of developing health problems in the future will be offered preventive services such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight loss and stress management.

This initiative is unique in using data and analytics to focus health care professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives across all PAMF locations. Cigna will compensate PAMF for the medical and care coordination services it provides. Additionally, the organization may be rewarded through a "pay for performance" structure if it meets its targets for improving quality and lowering medical costs. Employers who sponsor health plans will benefit from lower health care costs or health care costs that increase at lower rates.

"PAMF shares our vision for a patient-centered health care system that emphasizes prevention and primary care and rewards physicians for care quality and health outcomes," said Peter B. Welch, president for Cigna in northern California. "We believe that a system that's focused on value rather than volume of care offers the best path to improved health and lower medical costs, which is good for individuals, families, employers and doctors."

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 medical organizations. Cigna is now engaged in 38 patient-centered initiatives in 19 states, including six multi-payer medical home pilots and 32 Cigna-only collaborative accountable care initiatives. The collaborative accountable care initiatives encompass more than 300,000 Cigna customers and more than 45,000 primary care physicians.