Cigna and Adventist Health Network launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective January 1, 2014 and is Cigna's first collaborative accountable care initiative to launch in Illinois. Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations (ACOs). The program will benefit the more than 5,000 individuals covered by a Cigna health plan who receive care from Adventist’s 245 primary care physicians and 520 specialists.
Under the program, Adventist will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to be treated by their current physician and automatically receive benefits of the program. Patients most likely to see immediate benefits from the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.
Critical to the program’s success are registered nurses, employed by Adventist Health Network, who will serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the medical group and Cigna, which will ultimately provide a better experience for the individual. The care coordinators will enhance care by using patient-specific data from Cigna to help 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. The care coordinators are part of the physician-led care team that will help patients get the follow-up care or screenings they need, identify potential complications related to medications and help prevent chronic conditions from worsening.
Cigna will support a blended payment model, using fee for service, enhanced care coordination fee for enhanced medical home care and outcomes based payment adjustment for improvements in quality and affordability of care. Cigna will compensate Adventist for the medical and care coordination services it provides. Additionally, Adventist may be rewarded through a “pay for value” structure if it meets or surpasses targets for improving quality and lowering medical costs.
