Cigna and Commonwealth Primary Care ACO 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. Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations (ACOs). The program took effect January 1, 2014, and benefits over 7,000 individuals covered by a Cigna health plan who receive care from over 100 primary care physicians affiliated with Commonwealth Primary Care ACO.
Under the program, Commonwealth Primary Care physicians monitor and coordinate all aspects of an individual’s medical care. Patients continue to be treated by their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. Patients most likely to see the immediate benefits of 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 Commonwealth Primary Care, who 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 compensate the two physician organizations for the medical and care coordination services they provide. Additionally, they will be rewarded through a “pay for value” structure for meeting targets for improving quality and lowering medical costs.
