Cigna Collaborative Care Reduced Avoidable ER Visits by 16 Percent

Cigna’s second-year results from a collaborative care initiative with Granite Healthcare Network (GHN) reveals significant progress in improved health and affordability, and decreased avoidable emergency room (ER) visits by 16 percent, according to Cigna officials.

Cigna Collaborative Care, a partnership among five independent charitable healthcare organizations in New Hampshire which began in 2012, has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its more than 27,000 patients covered by a Cigna health plan. It is Cigna’s largest arrangement of this type in New Hampshire and Northern New England.

GHN’s overall quality performance remains better than the New Hampshire market with an overall rate of compliance with evidence-based medicine guidelines of 83 percent, driven by high quality results for cervical and breast cancer screening, adolescent well care, diabetes care and child access to primary care doctors. Additionally, GHN improved its closure rate for gaps in care by 8.3 percent. (Gaps in care refer to missed prescription refills, overdue screenings or lack of follow-up care for certain medical conditions.)

GHN also had superior results in affordability, with a market-leading 1.2 percent medical cost trend. This was largely driven by a sharp 16.2 percent decrease in avoidable ER visits (ER visits for non-emergency care), indicating that education and extended office hours are motivating GHN patients to seek care in the most appropriate setting, such as at the doctor’s office or an urgent care center. A 1.4 percent decrease in overall advanced imaging cost per scan (such as CT scans and MRIs) also contributed to the favorable medical cost trend.

Each of the GHN-participating organizations monitors and coordinates all aspects of an individual’s medical care. Critical to the program’s benefits are registered nurses (RNs), employed by all GHN healthcare organizations, who serve as clinical care coordinators and are integrated into the care delivery team to help individuals with chronic conditions or other health challenges navigate their healt care system.

The care coordinators enhance care by using patient-specific data provided by Cigna and the electronic medical record (EMR) to identify patients being discharged from the hospital who might be at risk for readmission, as well as individuals who may be overdue for important health screenings or who may have skipped a prescription refill. The 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.

The care coordinators also help individuals schedule appointments, provide health education and refer patients to specialized clinical programs, such as chronic condition management programs for diabetes, heart disease and other conditions. GHN’s patients are also referred to programs that help them quit smoking, control their weight or manage stress. More than 30 care coordinators across GHN have completed specialized training from Johns Hopkins University as Guided Care Nurses, setting these five health systems apart from other medical groups across the country.

Cigna compensates GHN for some medical and care coordination services its participating organizations provide. Additionally, the organizations are rewarded through a “pay for value” structure if they meet their targets for improving quality and lowering medical costs. Employers who sponsor health plans benefit from lower healthcare costs or healthcare costs that increase at lower rates.

Source: Cigna February 8, 2015

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This entry was posted in Accountable Care Organizations, affordable care act, Care Coordination, Case Managers, Case Managers and the Patient Experience, Diabetes, Disease Management, Elderly Care, electronic health records (EHRs), Emergency Room, Hospital Readmissions, Reducing Healthcare Costs and tagged , , , , . Bookmark the permalink.
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