Cigna Corp. is changing the way it funds medical care for small physician groups, hospitals and specialists, building on a model it brought to large physician groups in 2008.
The traditional fee-for-service model is still widely used, though health insurers have worked for years to change the way they pay for their customers’ medical services. Health insurers are increasingly moving to a collaborative care model, in which clinicians are paid to lower overall medical costs and improve patient care.
The goal is to “work with health care professionals to move away from a reimbursement that rewarded volume to one that rewarded outcomes. … And those outcomes are measured on the basis of quality, affordability and patient experience,” said Raegan Armata, a Cigna product director who has been leading the company’s collaborative care efforts.
Cigna’s arrangements with large physician groups, called Collaborative Accountable Care, started in 2008 and has reached agreements with 89 practices for a total of about 36,000 doctors across the U.S. Some results that Cigna highlights: fewer unnecessary visits to the emergency department; better compliance with diabetes treatment; greater continuity in care; and a rate of medical costs that is better than the market average.
Starting last year, the Bloomfield insurer has reached agreements with 29 small practices of physicians, totaling 60 physicians in four metropolitan areas.
The reason for expanding beyond large-group practices is to reach more people who have high-cost conditions or complex needs. Cigna’s research indicates that 20 percent of customers with high-cost conditions receive care from large-group practices. An example of a high-cost condition might be a person with diabetes and hypertension, or other “co-morbidities.”
“That’s actually what’s driven us to go into this direction,” Armata said.
The three new areas of focus — small physician groups, hospitals and specialists — each allow Cigna to reach different people with high-cost conditions. For example, Cigna estimates that 40 percent of its customers with high-costs conditions and complex needs are treated by small practices; 25 percent are treated at a hospital.
Specifically for hospitals, Cigna is measuring performance through a variety of metrics, such as hospital readmission rates, patient satisfaction, rates of maternity C-sections, and transition of care after discharge.
People with complex, costly medical conditions aren’t the entire focus.
“I think its concurrent,” Armata said. “You want to make sure that your healthy population remains healthy … but for those individuals that have health issues, we want to make sure that they are, in fact, getting to the doctors that are going to be in a position to really improve their quality of life.”