Posted on Jan 12, 2012 by Sergio Ulloa
US health insurance giant CIGNA Corp. is launching a new collaborative medical care initiative with a New York-based physician group that aims to deliver improved medical access and outcomes at reduced cost for members and will work in a similar manner to the accountable care organizations outlined by the Obama Administration's health care reform law.
Accountable care organizations, commonly referred to as ACOs, were introduced as part of the Patient Protection and Affordable Care Act in 2010. ACOs function as patient-centered networks of private healthcare providers that all agree to be made accountable for the overall care of their health plan members in exchange for additional compensation if they are able to improve health outcomes and reduce medical expenses.
On Wednesday, CIGNA announced that the Weill Cornell Physician Organization would be their partner in what will become the first accountable care initiative in New York that encompasses both a health plan and a physician organization. The move follows the establishment of a similar collaborative initiative between CIGNA and independent physician group Partners in Care in New Jersey last month. Nationwide, the Bloomfield, Connecticut-based health insurer is now running 11 accountable care programs across 10 states, with patient-centered initiatives now encompassing more than 170,000 Cigna policyholders and 1,800 primary care physicians. The insurer also participates in six multi-payer medical home initiatives across the USA.
According to a press statement released this week by CIGNA, the goal of all these ACOs is to ultimately provide a better service for policyholders through improved access to care and better coordination between medical providers. The statement outlined the company's "triple aim" of raising member satisfaction, improving health outcomes and reducing the overall cost of medical care. Those who are already covered by Cigna and use Weill Cornell primary physicians will not need to do anything to receive the benefits of the program.
Under this new collaborative program, all nurses employed by Weill Cornell's 71 primary care doctors will serve an additional role as clinical care coordinators for CIGNA policyholders. These registered nurses will use the patient-specific data provided by the health insurer to identify and reach out to patients discharged from their hospitals who might still be at risk for readmission, overdue for an important health screening, or someone who may have simply missed a prescription refill. These care coordinators will also work to help patients schedule doctor appointments, provide them with appropriate health information, and refer individuals to CIGNA's disease and lifestyle management programs, the statement said.
Dr. Alan Muney, CIGNA Chief Medical Officer, declared in the statement that these programs were working to transform medical practices nationwide by changing the payment system to reward for quality and outcomes rather than pay for volume. "We believe that initiatives such as this will help transform the way medicine is practiced in the United States from a system that's focused mainly on treating illness and rewarding physicians for volume to one that's patient-centred and emphasizes prevention and primary care. We've already seen very promising early results in locations where we've implemented this type of program, and we believe these initiatives ultimately will lead to a healthier population and lower medical costs," Muney commented, saying in addition that CIGNA has planned to continue increasing the number of such patient-centered initiatives nationwide throughout 2012
Weill Cornell's chief contracting officer, Dr. Michael Wolk, was on hand to confirm the sentiment. "Providing value-added, patient-centred health care is our number one priority. We look forward to collaborating with Cigna to deliver the right care at the right time in the right place," Wolk said, adding that patients that have needed greater help and communication in managing their chronic conditions, including diabetes and heart disease, would be the most likely to see the immediate benefits of the program.
This collaborative accountable care initiative between Cigna and Weill Cornell demonstrates perhaps the steps now necessary for health insurers and providers to encourage greater patient participation with healthcare professionals while keeping costs manageable. Health insurance in the United States has been primarily provided through private sector employers, who bear a large portion of the nation's healthcare costs. In times of limited economic growth it has thus become increasingly important for those involved in the country's health system to find a model that can lower costs while maintaining and improving overall employee health and productivity. Added to this has been the continued fervor over the Obama Administration's upcoming healthcare reforms. Under the Patient Protection and Affordable Care Act (PPACA) nearly all American citizens will have to carry health insurance by 2014 or else face a fine. The US Supreme Court has agreed to rule on whether the United States government can make its citizens engage in such commerce, with their verdict likely to be a critical issue in the run up to the country's general election in November. The individual mandate, if deemed legal, will put the US insurance industry in a bind
, with insurers having less control over whom they cover, which is predicted to drive up their medical expenses and drive down profits. Many insurance companies are therefore deciding look outside the country in order to offset the relatively low premium growth forecast in the USA.
Indeed, Cigna has proven to be one of the more proactive American insurers looking to develop their footprint in overseas markets
. As BRIC economies in particular continue to grow, Cigna plans to be at the forefront with an aggressive strategy to take advantage of the increasing demand for insurance and savings solutions in these countries. Industry analysts predict Cigna's international operations could grow to become a third of the company's total business within the next three to five years.
Insurance Company Mentioned
CIGNA Health Insurance is a global health service company dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation's operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, to approximately 46 million people throughout the United States and around the world.