RN Care Coordinators Contribute to Savings, Quality Improvement in Cigna Accountable Care Model

Registered nurses who serve as clinical care coordinators and help patients with chronic conditions to navigate the healthcare system are critical to the success of Cigna’s shared savings collaborative accountable care (CAC) program, according to a peer-reviewed study published in the November Health Affairs.

Interim results from Cigna’s CAC initiative, which was launched in 2008, indicate improvements in both quality of care and total medical cost management. The study reports on 2010 results from three geographically and structurally diverse physician practices: Dartmouth-Hitchcock in New Hampshire, Medical Clinic of North Texas (MCNT), and Cigna Medical Group of Arizona (CMG).

The study showed that CMG’s total medical costs for 2010 were significantly reduced ($27.04 per patient per month) compared with other practices in the same geographic area (p < 0.10). Compared with expected costs, Dartmouth-Hitchcock and MCNT achieved performance improvements in their per patient, per month costs ($1.78 and $6.56 respectively), although CMG showed a decrease of $4.94. The study also showed that the three practices out-performed their comparison group peers on all care quality measures, with one exception.

In the CAC program, care coordinators employed by the physician practice are aligned to a team of Cigna case managers to ensure a high degree of collaboration between the medical group and Cigna. The care coordinators enhance care by using patient-specific data provided by Cigna to 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. Care coordinators contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

Care coordinators also help patients schedule appointments, provide health education and refer patients to Cigna's clinical 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.

CAC is a shared savings program that offers practices up-front support in the form of care coordination payments in their first year of participation, and performance incentives for subsequent years if they meet targets for improved outcomes and lower medical costs. Cigna also provides CAC physician practices with performance reports that suggest opportunities for improving care quality and controlling costs. For example, the report might show that the practice’s patients are heavy users of hospital emergency rooms. This might suggest the need for the practice to offer extended evening or weekend hours to improve patient access to care.

Source: Cigna, November 12, 2012

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2012 Healthcare Benchmarks: Accountable Care Organizations This 60-page report documents the numerous ways in which accountable care is transforming healthcare delivery, population health management, reimbursement for care and, most importantly to this year’s survey respondents, the patient experience.

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