Cigna and doctors affiliated with two different Houston-area organizations -- St. Luke’s Health System Clinically Integrated Providers and Renaissance Physician Organization -- have launched collaborative accountable care initiatives to expand patient access to health care, improve care coordination, and achieve the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction.
Through the collaborative accountable care initiatives, doctors monitor and coordinate all aspects of an individual’s medical care. Patients continue to go to their current physician and automatically receive the benefits of the program.
Critical to the program’s benefits are registered nurses, employed by the physician practices, 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 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 helps 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 can also help patients schedule appointments, provide health education and refer patients 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 compensate physicians from the two organizations for the medical and care coordination services they provide. Additionally, the practices may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.
