Cigna Collaborative Care
is the company’s approach to accomplishing the same population health goals as accountable care organizations
, or ACO
s. The arrangement will benefit more than 4,000 individuals covered by a Cigna health plan who receive care from 150 MPS doctors.
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.
“Our mission is to deliver superior patient care and improve health care services for the people of Connecticut, which is aligned with the goals of Cigna Collaborative Care,” said David Printy, MPS executive director. “We look forward to working together with Cigna to bring
better health, affordability and patient experience to the people we jointly serve.”
“We’ve had great success with these types of arrangements throughout Connecticut and New England, and we’re pleased to have this opportunity to collaborate with MPS,” said Mark Butler, president and general manager for Cigna in New England. “When we reward doctors for the value of their care and focus on prevention, wellness, health improvement and care coordination, we can create a system that works for everyone who uses, pays for or delivers health care.”
Under the program, MPS doctors will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physicians and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from MPS 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 is the registered nurse clinical care coordinator, employed by MPS, who will help patients with chronic conditions or other health challenges navigate the health care system. Care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the physician group and Cigna, which will ultimately provide a better experience for the individual.
The care coordinator will enhance care by using patient-specific data from Cigna to help identify individuals being discharged from the hospital who might be at risk for readmission, as well as individuals who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinator is part of the physician-led care team that helps people get the follow-up care or screenings they need, identifies potential complications related to medications and helps prevent chronic conditions from worsening.
The care coordinator also helps individuals schedule appointments, provides health education and refers people to Cigna's clinical support programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.
Cigna will compensate MPS for the medical and care coordination services it provides. Additionally, the physician group may be rewarded through a “pay for value” structure if it meets 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. They 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.