Cigna is on track to reach its goal of 100 initiatives for 1 million customers by the end of 2014, Cigna officials report.
With the expansion of its collaborative ACO program through nine new initiatives with physician groups in seven states — Arizona, California, Colorado, Connecticut, Nevada, Oregon and Tennessee — Cigna now has 42 ACOs in 18 states covering more than 390,000 customers, officials report. Cigna launched its first collaborative ACO in 2008.
Critical to the programs’ benefits are RNs, employed by the physician practices, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the healthcare system. Care coordinators from each physician practice are aligned to 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 ACOs focus on the following:
- Expanding patient access to healthcare;
- Improving care coordination;
- Achieving the “Triple Aim” of improved health outcomes (quality), affordability and patient satisfaction.
Collaborative accountable care is Cigna’s approach to accomplishing the same population health goals as ACOs, with a strong focus on high-risk individuals, including people with chronic health conditions such as diabetes or heart disease.
To date, the ACOs have helped to improve patient health while curbing medical costs. The programs are also helping to close gaps in care, such as missed health screenings or prescription refills, and they’re reducing unnecessary use of hospital ERs, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to home.
For example, in 2011, Medical Clinic of North Texas (MCNT) improved total medical cost trends by 4.4 percent while maintaining quality (as measured by following evidence-based medical guidelines) at 4 percent better than the North Texas market. During the same period, EMHS (Eastern Maine Healthcare Systems) maintained quality at 5 percent better than its market. Also in 2011, Holston Medical Group had an overall ER visit rate that was 12 percent lower than its eastern Tennessee market, while avoidable emergency room visits for Cigna Medical Group were 24 percent lower than the Phoenix market.
Source: Cigna, October 18, 2012
Case Studies From Private-Sector ACOs: What Works and Why?provides details from those already navigating the many business decisions that must be made in setting up ACOs — on how the most successful private-sector ACO initiatives were formed, how they achieved results, and how they surmounted the hurdles that hamper delivery system reforms.