In January 2014, Cigna and two Fairfield County physician groups – PriMed and Greenwich Physicians Association, Inc. (GPA) - launched collaborative accountable care initiatives to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations (ACOs). The programs will benefit more than 12,000 individuals covered by a Cigna health plan who receive care from nearly 200 primary care doctors and specialists affiliated with PriMed and GPA. Under the program, the medical groups will monitor and coordinate all aspects of an individual's medical care. Patients will continue to go to their current physician and automatically receive program benefits. The program is expected to provide immediate benefits for those who need help managing chronic conditions such as diabetes, heart disease and obesity.
Critical to the programs are registered nurses or patient navigators, employed or engaged by the medical groups, 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 groups 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 compensate the physician groups for the medical and care coordination services it provides. Additionally, the medical group may be rewarded through a “pay for performance” structure if it meets targets for improving quality and lowering medical costs.
