Cigna and Loudoun Medical Group , one of the largest and most diverse physician-owned, multi-specialty group practices in Virginia, have 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 October 1, 2013.
Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program will benefit over 13,000 people covered by a Cigna health plan who receive care from over 200 Loudoun Medical Group primary care physicians and specialists.
Under the program, Loudoun Medical Group 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 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. There 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, heart disease and obesity.
Critical to the program’s success are registered nurses, employed by Loudoun Medical Group, 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 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.
As part of the agreement, Cigna will compensate physicians for the medical services they provide as well as for the care coordination services. Additionally, the practice may be rewarded through a “pay for performance” structure if it meets targets for improving quality and lowering medical costs.
