Cigna and Health Choice, a Physician Hospital Organization (PHO) affiliated with Methodist Le Bonheur Healthcare, have launched a collaborative accountable care initiative 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.
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.
Key to the program are registered nurses, employed by Cigna and Health Choice, who serve as clinical care coordinators and 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.
Cigna will pay physicians as usual for the medical services they provide. The physicians also will be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs. According to Cigna's McLaughlin, emphasizing the value of the primary care physician will help increase the professional satisfaction and financial rewards for doctors who practice in primary care.
