Complex Case Managers Crucial to New ACO

case managers

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Complex care managers will be key to a new ACO between Franciscan Alliance and Cigna aimed at enhancing care coordination and lowering overall costs, according to Cigna.

To achieve this, Franciscan Alliance and Cigna will work together, sharing clinical and care management information to provide coordinated, comprehensive healthcare services to patients in Central Indianapolis. Each organization will have aligned incentives to improve healthcare quality and patient service while reducing costs.

Critical to the program’s success will be complex case managers employed by Franciscan Alliance who will become part of the physician-led care team and serve as clinical care coordinators. They will help patients with chronic conditions or other health challenges navigate the healthcare system by doing the following:

  • Identifying patients discharged from the hospital who might be at risk for readmission;
  • Helping patients get follow-up care or screenings they need;
  • Identifying any issues related to medications; and
  • Helping prevent chronic conditions from worsening.

The care coordinators will use patient-specific data from Cigna to help them identify patients in need of these services and will be aligned to a team of Cigna case managers to ensure a high degree of collaboration between the two organizations. Care coordinators can also help patients schedule appointments, provide health education and refer patients to the Cigna health management and wellness programs that may be available to them through their employer’s benefit plan.

The long-term goal of the initiative, which launched January 1, is to build a delivery model that improves quality through better coordination of care, while reducing or eliminating unnecessary or duplicative costs.

Cigna is now affiliated with more than 50 collaborative accountable care initiatives in 22 states, encompassing nearly 510,000 Cigna customers and more than 14,000 doctors, including more than 6,500 PCPs and more than 7,500 specialists. Cigna launched its first ACO in 2008 and its goal is to have 100 of them in place with one million customers by the end of 2014.

The Franciscan Alliance ACO includes over 600 local physicians and five Immediate Care Centers located throughout the Indianapolis area.

Source: Cigna, January 28, 2013

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