Cigna Collaborative Accountable Care - Granite Healthcare Network
Program Location:
Concord, NH
Payer Type:
Commercial
Parent Program:
Payers:
Cigna
Reported Outcomes
Description:
Cigna's Collaborative Accountable Care, Granite Healthcare Network (GHN) program requires each of the GHN-participating organizations to 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 registered nurses, employed by each of the five GHN health care organizations, who serve as clinical care coordinators and are integrated into the care delivery team to help patients with chronic conditions or other health challenges navigate their health care system. The care coordinators will enhance care by using patient-specific data provided by Cigna 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 contact these individuals to help them 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 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.
This initiative is unique in using data and analytics at the health system level to focus health care professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives across the GHN member health systems.
Payment Model:
Cigna will compensate GHN for the medical and care coordination services its participating organizations provide. Additionally, the organizations may be rewarded through a “pay for performance” structure if they meet their targets for improving quality and lowering medical costs. Employers who sponsor health plans will benefit from lower health care costs or health care costs that increase at lower rates
Fewer ED / Hospital Visits:
- Emergency room use reduced by 4 percent
- Advanced imaging (MRI and CT) use reduced by 7 percent
Improved Access:
- Improvements in closing gaps in care
Cost Savings:
- Medical cost trend was 1.2 percentage points better than New Hampshire market
- Emergency room cost trend reduced by 8 percent
- Advanced imaging (MRI and CT) cost trend reduced by 4 percent
Increased Preventive Services:
- Better-than-market quality results for cancer screenings, diabetes care, adolescent well care
Data Source(s):
Last updated September 2014
