Cigna, Santa Clara County IPA partnership lowers medical costs, readmission rates

Cigna sign
Cigna's care collaboration is saving patients in Silicon Valley 18% on medical expenses. (Cigna)

A care collaboration between Cigna and the Santa Clara County Individual Practice Association (SCCIPA)—a group of 240 primary care physicians and 600 specialists—is driving better healthcare to 18,000 residents in Silicon Valley and saving participants 18% on medical costs.

SCCIPA uses patient-specific data collected by Cigna to identify patients at risk. For example, the system follows individuals being discharged from the hospital, in need of health screenings or that skipped a prescription refill.

According to Cigna, total medical costs for SCCIPA participants are 18% below the market average. Further, participants have given the group’s quality score a 20% improvement as care for patients with cardiac conditions, diabetes and depression improved. 

RELATED: Cigna’s strong start to 2019 backed by Express Scripts deal

Other improvements include a 23% lower readmissions rate than average, 10% fewer inpatient admissions, 9% fewer emergency department visits, 32% fewer uses of advanced imaging and 20% lower inpatient medical costs.

“SCCIPA has years of deep experience managing risk-based contracts and HMO populations. Using population health management to drive value is embedded in their DNA. Success begets success,” Ken Phenow, M.D., market medical executive for Cigna in Northern California, told FierceHealthcare.

SCCIPA uses a web-based portal that is available to all of its providers. Phenow says access to critical patient information—labs, tests and scans, to name a few—helps avoid costly duplication and enables the team to provide the most appropriate care.

“The portal minimizes the number of clicks needed to find valuable patient information,” he said. “They are integrating a new population health platform into their current platform, which we expect improve care coordination, patient engagement and navigation, all of which contribute to improved quality outcomes and greater patient satisfaction.”

RELATED: What the CEOs of the 8 largest insurers earned in 2018

The two entities began working together in 2014, and in 2018 SCCIPA was named the top-performing Cigna Collaborative Care group in the country. Since 2018, SCCIPA is also part of an alliance between Cigna and the Good Samaritan Health System that includes a customized network of primary care doctors, specialists and hospitals.

The collaboration has both perks and challenges. Phenow says a key benefit is that the partnership enables better care that’s more affordable. The biggest challenge is the decentralized nature of an IPA; however, SCCIPA’s web-based portal really helps overcome that.

“Because of the success and mutual support, the traditional medical group-health plan relationship has turned into an extremely collaborative and rewarding one,” he added.

Looking toward the future, Cigna is developing a medical neighborhood model with SCCIPA that will focus on emergency room triage to help people choose between urgent or emergency care. The medical neighborhood would also provide more “eyes” on the SCCIPA population that could better close gaps in care and proactively identify potential issues and direct patients to the right provider.

“We are also recruiting SCCIPA specialists into some of our episode of care programs to better align the primary care physician, who is the ‘quarterback’ of care, with the specialists in the group,” Phenow said. “With aligned incentives across the neighborhood’s providers, coupled with a laser focus on delivering the highest level of quality outcomes and high-value care, we will change the way that health care is organized, delivered and reimbursed."