Collaborative Accountable Care: CIGNA’s Approach to Accountable Care Organizations

An Accountable Care Organization (ACO) is any organization that takes on the responsibility for achieving the triple aim-improving the quality, affordability and experience of care for the population it serves. A typical ACO can consist of primary care groups, multispecialty groups or integrated delivery systems, like a multi-specialty hospital system. The key is that the group directly provides or coordinates the majority of their patients’ care. 

The best examples of the ACO model today are the 10 groups that participated in the Medicare Physician Group Practice (PGP) Demonstration started in April 2005. Medicare beneficiaries were assigned to a physician group based on their previous use of that group for care. Medicare beneficiaries did not have to sign up for the group and could continue to go to any participating national Medicare physician. 

During the five-year demonstration, the Centers for Medicare and Medicaid Services (CMS) rewarded physician groups for improving patient outcomes by proactively coordinating their patients’ total health care needs, especially for beneficiaries with chronic illness, multiple comorbidities and transitioning care settings. Participating doctors received their regular Medicare fee-for-service payments. However, the groups were also eligible for “performance payments” if the practitioners collectively achieved specified quality and cost targets for the beneficiaries “attributed” to their group. The majority of the participating groups performed well enough to achieve a reward. In fact, the pilot was so successful that CMS is planning a new program scheduled to begin in 2012.

Since 2007, CIGNA has been piloting our new care delivery model with several physician and hospital groups across the country. CIGNA has studied both specific program components and overall achievement of quality and total medical cost goals. Results from some of our earliest pilots show the model is working to drive better results: 
Dartmouth-Hitchcock Clinic, New Hampshire
One important component of our CAC initiative is the embedded care coordinator role within the practice and, in particular, the effort this clinician makes to reach out to patients with “gaps in care.” In New Hampshire, a matched-case control study compared CIGNA customers in two groups. The first group was receiving care from the Dartmouth-Hitchcock system with its embedded care coordinator. The second group of customers was receiving standard care from other health care professionals in New Hampshire without care coordination support. The study showed: 

• 10.4% higher overall improvement in gaps in care closure rates over six months
• 13.8% higher gaps in care closure rate for high-priority patients
• 16% higher gaps in care closure rate for patients with hypertension
• 8.1% higher gaps in care closure rate for patients with diabetes