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Cigna Collaborative Care Improved Quality and Lowered Health Care Costs Statewide

Rationale / Objectives

Chronic conditions, such as diabetes and heart disease take a toll on millions of Americans, as healthcare costs escalate. The problem primarily stems from the ineffective system for rewarding physicians: they are paid for volume and performing more procedures rather than value and quality (positive patient health outcomes).

Cigna Collaborative Care Program had triple aim; Improve health outcomes (quality), lower total medical costs and enhance patient experience. These will be achieved by monitoring and coordinating all aspects of an individual's medical care. Transforming America's healthcare delivery system into one that's outcomes-oriented. 1 2

Project/Program Description & Major Achievements

This initiative is unique in using data and analytics at the health system level to focus health care professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives across the Granite Healthcare Network (GHN) member health systems.

The program requires each of the GHN-participating organizations to monitor and coordinate all aspects of an individual's medical care.

Collaboration and coordination between Cigna and GHN has resulted in significant improvements in quality, affordability and closing gaps in care a 10% improvement overall, 16% for hypertension and 8% for diabetes compared to other physician practices in the market that don't employ care coordinators. Emergency room use reduced by 4%. Advanced imaging (MRI and CT) use reduced by 7 %. Medical cost trend was 1.2 %points better than New Hampshire market. Emergency room cost trend reduced by 8%. Advanced imaging (MRI and CT) cost trend reduced by 4 %. 1 2 3

Lessons Learned

It is very important to use data and analytics at the health system level to focus health care professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives. 2

Further Description

Cigna's Collaborative Accountable Care, Granite Healthcare Network (GHN) program required each of the GHN-participating organizations to monitor and coordinate all aspects of an individual's medical care. They hired a nurse as a care coordinator to utilize patient-specific data provided by Cigna. Cigna identified patients being discharged from the hospital at risk for readmission, others overdue for important health screenings and other issues.. The care coordinator contacted them, helped them get the follow-up care or screenings they needed, helped patients schedule appointments, and provided health education. The care coordinator also referred patients to Cigna's clinical programs, such as disease management programs and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management  The physician practices improved appointment availability including evening and weekend hours, offered case and disease management services, and used electronic medical records to better track medical history. Cigna’s pharmacists consulted with the care coordinators by phone, and provided guidance and assistance with medication compliance. They  facilitated switches to lower-cost alternatives and offered Cigna Home Delivery Pharmacy services to help individuals stay compliant and save money on their regular medications. 1

Major Achievements

Cigna’s GHN program rewarded the physician practice for improving patient health (quality) and for lowering total medical costs. 2

Metric

Result

Detail

Emergency room use  

Reduced by 4%  

Cigna, 2013

Emergency room cost trend

Reduced by 8%

 

Advanced imaging (MRI and CT) use  

Reduced by 7%

 

Advanced imaging (MRI and CT) cost

Reduced by 4%

 

Quality advantage

3% compared to market

Cigna 2015

Medical cost trend

Increased 1.2 % > New Hampshire market.  

 

Closure rate for gaps in care

Improved by 8.3%