AHIP Institute: How Cigna realigns incentives with providers, pharma

Cigna CEO David Cordani speaking on stage at AHIP

LAS VEGAS--Through value-based partnerships with pharmaceutical manufacturers and providers, health insurers are transforming misaligned incentives in the healthcare system that can have disastrous consequences, Cigna CEO David Cordani (above) said Thursday at the 2016 AHIP Institute.

One example of great clinical interventions having unintended consequences is the “dramatic, massive, unsustainable spike in the consumption of opioids,” Cordani said. “In short, we’re quickly poisoning ourselves.”

Cigna has taken a leading role in the fight against the crisis, pledging to reduce opioid use among members by 25 percent in three years and to treat substance abuse disorder as a chronic disease. There’s no business incentive to do so, but it’s “fundamentally the right thing to do,” Cordani said, adding that he’s confident other payers will follow suit.

As shocking as the escalation of the opioid addiction crisis has been, Cordani also noted that the cost profile of some specialty medications has “taken some people’s breath away.”

Yet the clinical outcomes that some of them offer is just as breath-taking in some cases, signaling an opportunity for value-based contracts with manufacturers that reward outcomes rather than consumption. Cigna has pursued several such arrangements with pharma companies, including one announced this February for Novartis' heart medication Entresto

“This method of getting alignment, from our point of view, is mission critical.” Cordani said.

Cigna is also striving to align incentives with providers through its Collaborative Accountable Care organizations, the company’s version of ACOs.

In order to make those value-based partnerships work, he added, more than just financial incentives have to come into play--the parties’ leaders must be on the same page. “The No. 1 enabler is philosophical alignment of leadership,” Cordani said. “The number one disabler is lack of philosophical alignment of leadership.”

The barriers to clinical data sharing also present a challenge--particularly when it comes to behavioral healthcare--though Cordani noted Cigna is working with government regulators to ease that burden.

When done right, though, value-based contracts with pharmaceutical manufacturers also go “hand in glove” with value-based care partnerships with healthcare providers, Cordani added.

In his view, when physician groups have the information and care managers they need to tackle population health, they then have the infrastructure to leverage a value-based pharmaceutical relationship.

“When you have the ability to pull them together, Cordani said, “There’s a lot of power.”