The participating physician practices will monitor and coordinate all aspects of an individual's medical care. Patients will continue to go to their current physician and will not need to do anything to receive the benefits of the program. There also are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.
Critical to the program's benefits are clinicians and registered nurses, employed by Partners In 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 will enhance care by using patient-specific data that Cigna provides to 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 will work with the patient's physician to help patients 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 will also help an individual's medical home provide health education and refer individuals to Cigna's clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.
Cigna will pay physicians as usual for the medical services they provide. Partners In Care will also pay the physicians for the care coordination services they provide on the patient’s behalf. Additionally, physicians may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.
