The care coordinator role at Dartmouth-Hitchcock, Cigna's accountable care model

In their own take on accountable care, Dartmouth-Hitchcock Medical Center and Cigna Healthcare partnered to create "collaborative accountable care." Since the health system and insurer paired up three years ago in this initiative, the two organizations have reported success in managing patient care.

How did they do it? Among the three tenets are improved informatic services, alignment of incentives, and better clinical services.

One key component of improving clinical services and making the alliance work is the role of the care coordinator that many other organizations currently are experimenting with across the country. Sometimes called a healthcare navigator, health coach, or case manager, the Dartmouth-Hitchcock and Cigna version is called a "care coordinator." The care coordinator is a registered nurse employed by Dartmouth and embedded in physician practices and clinics to manage at-risk patients that the two organizations identify through detailed reports as having possible complications down the road.

"It's really managing our most complicated patients, and we really focus on bridging care across transition points," said Sheila Johnson, ACO project director at Dartmouth-Hitchcock, in a recent FierceHealthcare webinar, "Accountable Care Pilots: Lessons Learned from Multi-year Demonstrations."

After participating with the Medicare Physician Group Demonstration Project, Dartmouth wanted to apply that success in transitional care with the insurer. With Cigna's high-acuity members at 3 percent of the 19,000 members, Dartmouth built on their existing chronic disease registry and a preventative registry with Cigna's reporting system to identify patients that have gaps in evidence-based medicine.

For instance, one of the reports is an inpatient admission report that details if patients are hospitalized in any hospital in the U.S. "[T]hat helps us be able to coordinate their care and transition them from the hospital to home," said Dick Salmon, national medical director at Cigna.

Regarding chronic condition patients, records of a diabetic patient who smokes, has multiple medications, and a history of foot ulcers might reveal that she also has missed doctor appointments, is missing lab work, has visited the emergency room three times so far, and previously was admitted to the hospital as an inpatient for septicemia. The care coordinator then works with that at-risk patient to identify gaps in care.

For example, at the Keene (N.H.) campus, the care coordinator visits the patient, follows up with her after discharge, and accompanies the patient to appointments. If the patient says she cannot afford the needed medications, the care coordinator works to provide alternative, less expensive generics. The care coordinator might also schedule follow-up appointments, give the patient information about nearby health education programs, and generally answer any questions the patient might have.

"Our patients love what we're doing for them, and they just have found this to be very satisfying. As a nurse, I find it satisfying as well that we're able to do the type of work that we were trained for and love to do," said Johnson.

For more information:
- register for the free webinar on-demand
- read the transcript (.pdf)

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