Cigna (CI) has launched a collaborative care initiative with PinnacleHealth in central Pennsylvania. The aim of the program is to improve patient access to health care, enhance care coordination, and achieve the goal of improved health, affordability and patient experience. Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs.
In places where it’s been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while effectively managing medical costs. The programs are helping to close gaps in care,
such as missed health screenings or prescription refills, reinforcing the appropriate use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to home.
“Chronic disease incidence is one of the top challenges facing the U.S. healthcare system today. There are multiple factors that contribute to an individual’s health,” says Michael A. Young, president and CEO of PinnacleHealth. “By pursuing innovative partnerships and embracing new roles, we can identify and address the root causes of illness, provide the right care and solve problems that lead to poor health.”
“We need a patient-centered health care delivery system that emphasizes prevention and primary care and rewards health care professionals for quality of care and improved health outcomes,” said Julia Huggins, Cigna president for Pennsylvania. “A system that’s focused on value rather than volume will ultimately lead to a healthier population and lower medical costs, which is good for individuals, families, employers and doctors.”
Under the program, PinnacleHealth physicians will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current doctor 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 PinnacleHealth physician 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 benefits are the registered nurse clinical care coordinators, employed by PinnacleHealth, who will 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 PinnacleHealth and Cigna, which will ultimately provide a better experience for the individual.
The care coordinators will enhance care by using patient-specific data from Cigna to help identify individuals who may be overdue for important health screenings or who may have skipped a prescription refill, as well as individuals who have had a recent emergency room visit. The care coordinators are part of physician-led care teams that will help people get the follow-up care or screenings they need,
identify potential complications related to medications and help prevent chronic conditions from worsening.
Care coordinators can also help individuals schedule appointments, provide health education and refer people to Cigna's clinical support programs that are part of their employer’s health plan.
Cigna will compensate PinnacleHealth physicians for the medical and care coordination services they provide. Additionally, doctors may be rewarded through a “pay for value” structure for meeting targets for improving quality and lowering medical costs.
Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 134 Cigna Collaborative Care arrangements with large physician groups that span 29 states, reach nearly 1.5 million commercial customers and encompass nearly 60,000 doctors, including approximately 30,000 primary care physicians and 30,000 specialists.