- Reduced emergency room visits for
non-emergency care
- Gaps in care closed and better care
coordination for chronic conditions such as diabetes
- More cost-effective use of advance
imaging such as CT scans and MRI
Medical practices in Connecticut that participate in the Cigna
(NYSE: CI) Collaborative Care initiative are having success
improving quality and lowering medical costs, which is what the
program was designed to do. Cigna Collaborative Care is the
company’s approach to accomplishing the same population health
goals as accountable care organizations, or ACOs: improved health,
affordability and patient experience.
“When gaps in care are closed, when doctors follow
evidence-based medicine guidelines, when individuals get care in
the proper setting rather than the emergency room, the quality of
care goes up, people are healthier, they have a better experience
and costs are reined in,” said Robert Hockmuth, M.D., senior
medical director for Cigna in Connecticut. “That’s really what
Cigna Collaborative Care is all about, and these medical groups are
excellent examples of how well it’s working.”
Farmington-based ProHealth Physicians was among the first
medical groups to participate in Cigna Collaborative Care. When the
group started collaborating with Cigna in October 2009, it was the
first program of its kind in Connecticut to focus on enhanced care
coordination and physician pay-for-value for meeting targets for
quality and cost improvements.
ProHealth has focused strongly on reducing unnecessary emergency
room use (ER visits for non-emergency care), and as a result, its
emergency room use is 7 percent lower than market. ProHealth
accomplished this significant improvement mainly by opening urgent
care clinics in areas where people with high ER use lived, making
it easier for them to get the right care at the right time in the
right setting.
Another area of success for ProHealth has been closing gaps in
care for chronic conditions. (Gaps in care refer to overdue
screenings or lack of follow-up care for certain medical
conditions, as well as missed prescription refills.) For example,
ProHealth outperforms the market by 9 percent on diabetes measures,
which means its diabetic patients are receiving testing and
treatment according to the recommended guidelines. That helps these
individuals avoid medical complications and potential higher cost
care in the future.
The price of advanced imaging, such as CT scans, can vary
considerably by location, which is a strong driver of medical
costs. ProHealth’s 37 percent referral rate to preferred providers
of CT scans and MRI outperforms the market, and by focusing on
evidence-based guidelines, its use of advanced imaging is 16
percent better than market.
“ProHealth is pleased to be among the first participants in
Cigna Collaborative Care,” said Jim Cox-Chapman, M.D., chief
medical officer for ProHealth. “We have enjoyed the opportunity to
work with our payer partners to improve the health care experience
for our shared population. Cigna was among the first health plans
in our state to recognize the value of such collaboration, and we
are delighted to have consistently demonstrated our success in both
quality improvement and managing health care expenses.”
Community Medical Group is an integrated network of
physicians and other health care professionals that has
participated in Cigna Collaborative Care since October 2012. The
group’s total medical cost is trending 1.9 percent better than
market and its success rate with evidence-based medicine guidelines
is better than market at 85.3 percent.
The group has a strong focus on reducing avoidable emergency
room use. By encouraging its patients to use its primary care
providers and urgent care centers that participate in Cigna's
network, avoidable ER visits per thousand have decreased by 23
percent, while overall ER visits decreased 10 percent, and ER
visits by individuals considered to be “frequent users” decreased
by 12 percent.
Community Medical Group’s use of scans per thousand is trending
12 percent better than market and its advanced imaging cost has
decreased 14 percent due to increased patient referrals to
preferred providers who offer quality imaging at a lower cost.
The group has put a strong focus on following evidence-based
medicine guidelines and has had its best success with diabetes: 96
percent of its diabetes patients have the HbA1c (blood sugar) test.
The group has also had success closing gaps in care, in particular
for treatment of high cholesterol at 2 percent better than market
and epilepsy at 15 percent better than market.
Community Medical Group also implemented an initiative to
improve treatment with injectable specialty medications. One of its
patients needed intravenously administered immunoglobulin (IVIG)
and the group helped redirect the hospital-based treatment to
home-based care. By having the treatment at home, the individual
did not have to miss work days and saved $400,000 in medical
costs.
“We joined the Cigna Collaborative Care initiative because we
saw it as an opportunity to improve the quality of our care as well
as an opportunity to help make health care more affordable,” said
Joseph Quaranta, M.D., president, Community Medical Group. “These
successes show that we’re moving in the right direction.”
Putnam-based Day Kimball Healthcare and its affiliated
physicians group is an integrated medical services network serving
northeast Connecticut that has participated in Cigna Collaborative
Care since October 2012. The group is showing solid improvements in
both quality and cost, with improved breast cancer screening,
diabetes care and cervical screening driving quality results. Its
rate for closing gaps in care improved 7 percent last year compared
to the year before.
In addition, overall emergency room use is down and is trending
3.4 percent better than market while avoidable emergency room
visits (visits for non-emergency care) are down 9 percent year over
year. The group’s medical cost trend is beating the Connecticut
market by 4.2 percent.
Much of Day Kimball’s success can be attributed to the care
coordinators - registered nurses employed by the medical group who
help individuals navigate the health care system, help them get the
follow-up care or screenings they need, identify any issues related
to medications and help prevent chronic conditions from
worsening.
For example, when Cigna customers are hospitalized at Day
Kimball Hospital, the care coordinator visits them at their bedside
for an initial transition of care discussion, and then reaches out
within two business days after discharge. The care coordinator
identifies individuals who could benefit from Cigna clinical
programs, such as stress or weight management, or chronic condition
management for diabetes, and coordinates with Cigna to enroll
individuals in those programs. The care coordinator also identifies
individuals who have a high health risk score and collaborates with
an aligned Cigna case manager to discuss the most appropriate plan
of care.
“I can’t emphasize enough how important the care coordinator is
to the success of this program,” said John N. Graham, M.D., chief
medical officer for Day Kimball. “The care coordinator is an
essential member of the clinical team who follows up with our
patients and makes sure they get connected to the resources they
need to manage their health.”
About Cigna
Cigna Corporation (NYSE: CI) is a global health service company
dedicated to helping people improve their health, well-being and
sense of security. All products and services are provided
exclusively by or through operating subsidiaries of Cigna
Corporation, including Connecticut General Life Insurance Company,
Cigna Health and Life Insurance Company, Life Insurance Company of
North America and Cigna Life Insurance Company of New York. Such
products and services include an integrated suite of health
services, such as medical, dental, behavioral health, pharmacy,
vision, supplemental benefits, and other related products including
group life, accident and disability insurance. Cigna maintains
sales capability in 30 countries and jurisdictions, and has more
than 88 million customer relationships throughout the world. To
learn more about Cigna®, including links to follow us on Facebook
or Twitter, visit www.cigna.com.
Community Medical Group
The Community Medical Group, Inc. is an integrated network of
physicians, podiatrists, midlevel practitioners, and other licensed
healthcare providers dedicated to providing the communities they
serve with appropriate access to care, clinical services excellence
and the prudent use of resources. Founded in 1987, Community
Medical Group includes 750 providers in over 300 practices located
throughout New Haven County and Fairfield County. Community Medical
Group is a Connecticut corporation governed by an elected physician
Board of Directors that is responsible for the governance and
management of the organization.
About Day Kimball
Day Kimball Healthcare is a non-profit, integrated medical
services provider comprised of Day Kimball Hospital, healthcare
centers in Danielson, Dayville, Plainfield and Putnam, Day Kimball
HomeCare, Hospice & Palliative Care of Northeastern CT, Day
Kimball HomeMakers, and Day Kimball Medical Group. Its service area
includes Northeast Connecticut as well as nearby Massachusetts and
Rhode Island communities. Day Kimball Healthcare’s comprehensive
network offers more than 1,400 employees including nearly 300
associated, highly-skilled physicians, surgeons and specialists.
Its website is daykimball.org.
About ProHealth
Based in Farmington, CT, ProHealth Physicians is Connecticut’s
largest physician-owned healthcare delivery system, operating 95
practices, serving over 380,000 active patients, and completing
over 850,000 patient encounters per year. Formed in 1997, ProHealth
has grown to include more than 350 primary care and specialty
providers and offers select specialty and diagnostic/therapeutic
services such as ENT, pediatric and adult gastroenterology, plastic
surgery, imaging, physical therapy, sleep medicine services, ADHD
diagnosis and treatment, audiology, neurology, and regional Express
Care walk-in centers to meet patients’ needs for access and
convenience. For the past 15 years, ProHealth’s clinical
performance program has enabled its providers to identify patients
who are due for specific healthcare screenings and tests based on
the clinical guidelines relevant to the individual patient’s
condition. ProHealth has participated in the Medicare Shared
Savings Program since 2013 and is contracted to care for more than
100,000 patients through commercial shared savings agreements.
ProHealth cares for over 10% of Connecticut’s population and
continues to expand throughout the state.
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version on businesswire.com: http://www.businesswire.com/news/home/20150520005296/en/
CignaMark Slitt, 860-226-2092mark.slitt@cigna.com
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