CIGNA's Collaborative Accountable Care Programs Improving Quality and Reducing Costs

BLOOMFIELD, Conn., March 24, 2011 - Preliminary results from two of CIGNA's collaborative accountable care pilot initiatives - CIGNA's approach to accountable care organizations, or ACOs - show that quality is improving and costs are being reduced. In New Hampshire, Dartmouth-Hitchcock is closing gaps in care 10 percent better than the market, while in Phoenix, Cigna Medical Group has lowered average annual costs per patient by $336. CIGNA plans to build on these successes with a national expansion of its accountable care initiatives in 2011.

Since October 2007 when it joined the Patient-Centered Primary Care Collaborative, and June 2008 when it launched its first collaborative accountable care program with Dartmouth-Hitchcock, CIGNA (NYSE: CI) has engaged in continuous efforts to help reshape the nation's health care delivery and payment systems through accountable care organizations. These are collaborations between a health plan and a medical practice that's responsible for the care delivered to a specific group of people. The goal is to achieve the "triple aim" of improved quality, lower medical costs and improved patient satisfaction by creating a care model anchored in the principles of the patient-centered medical home that also builds in accountability by rewarding physicians for results.

A key element of CIGNA's programs is the sharing of "gaps in care" data with a care coordinator at the physician practice. The care coordinator then contacts the patient to ensure that, for example, follow-up appointments are scheduled, prescriptions are filled or additional medical tests are completed. In the case of Dartmouth-Hitchcock, this type of collaboration and coordination has resulted in a 10 percent improvement in the practice's overall closure rate for gaps in care compared to other physician practices in the market where patient care isn't coordinated. For hypertension, Dartmouth-Hitchcock shows a 16 percent gap closure improvement compared to the market, and for diabetes an eight percent improvement.

At Cigna Medical Group, the Phoenix-based multi-specialty medical group practice division of CIGNA HealthCare of Arizona, a strong focus on the patient and improved care coordination has resulted in average annual savings per patient of $336. The cost of ambulatory surgery is down 11 percent, while preventive care visits are up three percent overall - and up 12 percent for adults. Because of its strong focus on appropriate treatment, consistent follow-up and fewer unnecessary tests, Cigna Medical Group enjoys a seven percent cost advantage and a three percent quality advantage compared to the market.

"Through our patient-centered collaborative accountable care initiatives we aim to transform the medical delivery system by rewarding physicians for results rather than volume," said Dr. Dick Salmon, CIGNA's national medical director for performance measurement and improvement. "We expect a focus on coordinated, comprehensive care will strengthen the patient-doctor relationship and result in greater value through better outcomes for patients and lower overall medical costs. We're still in the early stages, but we're clearly on the right track toward achieving these goals, which is why we plan a major expansion of these programs in 2011."

According to Salmon, CIGNA expects to have implemented or be in the active planning stage with approximately 30 initiatives by the end of the year, up from the eight CIGNA-only programs and four multi-payer pilots in which CIGNA now participates.

CIGNA's accountable care initiatives are focused on its principal clients and customers - employers who sponsor health plans on behalf of their employees.

"Employers bear a significant part of health care expenses in the U.S., so they're extremely interested in accountable care organizations and other patient-centered programs that can improve the health and productivity of their employees and lower overall medical costs," said Helen Darling, president and CEO of the National Business Group on Health. "Now more than ever, employers need to get the most for their health care dollar and they want health plans to implement innovative programs that will improve quality and bend the health care cost curve. I commend CIGNA for taking a leading role through its collaborative accountable care initiatives and congratulate CIGNA for the quality and cost improvements it has achieved so far in collaboration with physician practices."


While there has been much focus over the past year on the concept of accountable care organizations, Salmon points out that CIGNA's collaborative accountable care model is slightly different. "Our model of collaborative care is an ACO that's built on patient-centered medical home principles and a heavy emphasis on collaboration and communication. CIGNA physicians and nurses have frequent contact with doctors and nurses at the physician practices to help with coordination of patient care."

According to Salmon, one of CIGNA's goals is for physicians to see CIGNA's clinical programs as an extension of their own practice and refer patients into CIGNA's 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. But it's the sharing of patient-specific data to foster more coordinated, comprehensive care that's key.

"With the gaps-in-care and other patient-specific data CIGNA provides, we are able to more effectively follow-up with patients to see they get any additional care they may need," says Dr. Barbara Walters, senior medical director for Dartmouth-Hitchcock. "Identifying patients who may have diabetes and helping them control their blood sugar level, or ensuring that someone being discharged from the hospital receives appropriate follow-up care to prevent readmission, presents a significant opportunity for improving health and lowering overall medical costs."

Collaboration extends beyond CIGNA and the individual physician practices that participate in the initiatives - it also includes collaboration among the physician groups. Last month CIGNA convened the first of what it expects to be quarterly meetings with key representatives from the participating physician practices. This first "learning collaborative" was an opportunity for the physician groups to share information with one another about best practices in care coordination with a focus on managing gaps in care.

"By convening these sessions, it's not only a learning opportunity for CIGNA but also for the physician practices. Meeting regularly to share ideas and experiences will help us fully realize the potential of our collaborative accountable care programs," said Salmon.

CIGNA is now engaged in 12 patient-centered initiatives in 11 states, encompassing 100,000 CIGNA customers and 1,800 physicians. These programs include multi-payer pilots in Colorado, New Hampshire, Pennsylvania, and Vermont, as well as CIGNA-only collaborative accountable care initiatives in Arizona, Connecticut, Georgia, Maine, Missouri, New Hampshire, Tennessee and Texas. CIGNA has been a member of the Patient-Centered Primary Care Collaborative since October 2007.

CIGNA (NYSE: CI) is a global health service and financial company dedicated to helping people improve their health, well-being and sense of security. CIGNA Corporation's operating subsidiaries in the United States provide an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance. CIGNA offers products and services in over 27 countries and jurisdictions and has approximately 65 million customer relationships throughout the world. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Life Insurance Company of North America, CIGNA Life Insurance Company of New York, and Connecticut General Life Insurance Company. To learn more about CIGNA, visit To sign up for email alerts or an RSS feed of company news, log on to Also, follow us on Twitter at @cigna, visit CIGNA's YouTube channel at and listen to CIGNA's podcast series with healthy tips and information at or by searching "CIGNA" in iTunes.