When payers and providers collaborate, they often achieve positive results. Patient care becomes coordinated, costs drop and quality enhances. That's what Cigna's Dick Salmon (pictured left), vice president of performance management and improvement, explained during a recent FierceHealthPayer webinar about how payer and provider collaborations can improve population health.
Although teaming up with providers isn't always the easiest undertaking, it helps when payers can form relationships based on open communication, clear standards and trust.
To help FierceHealthPayer readers learn more about Cigna's unique collaborative accountable care program, Salmon answered some follow-up questions after the webinar.
Q: What kinds of tools or data does Cigna offer to providers to help them set up a collaborative care program?
Dick Salmon: Cigna provides both tools and resources to help with advanced care coordination. In each of our initiatives, the embedded care coordinator (ECC) position is established as an employee of the healthcare professional group. This individual is responsible for outreaching to high-risk individuals and ensuring appropriate, coordinated care. We provide the ECC with a daily list of who is in the hospital and will require a transition of care call at the time of discharge to ensure appropriate follow-up and knowledge about medications.
We also provide the ECC with a monthly list of high-risk patients who have multiple "gaps in care," medication compliance issues, multiple visits to the emergency room, and the like, so the ECC can outreach and coordinate care.
We also offer ongoing training and best practice sharing for these nurses. And, we connect these nurses with Cigna resources--including case managers, wellness coaches, behavioral coaches and pharmacists--to bring to their patients an expanded team of clinical resources.
We also provide quarterly performance reports, which allow the healthcare professionals to monitor whether their initiatives are working, as well as overall monitoring of total medical cost and quality trends. For example, we provide a "gap in care" closure report and an ER visit frequency report.
Q: How do you define cost of care for providers? Do you show the allocation of costs within the market basket of services?
Salmon: Cost of care is defined as the risk-adjusted total medical cost for their aligned population. Alignment is based on the population of patients who receive the majority of their primary care from the group. The risk adjustment for total medical cost is determined by first removing the costs over $100,000 for any individual in a 12-month period, and then applying the Symmetry Episode Risk Group risk adjustment methodology.
Our goal is to hold healthcare professionals to clinical accountability, not to transfer insurance risk. We do show the allocation of these costs by type of service and then by multiple sub reports (such as type of specialty within physician costs, inpatient utilization and costs, ER utilization and costs, imaging utilization and costs, and pharmacy utilization and costs). These reports are available at the overall group level as well as for sub-groups, minor groups and individual physicians.
Q: What is the process for a provider group to become involved in the Cigna program?
Salmon: For Cigna's collaborative accountable care programs, we are looking for partners who have a full organizational commitment to the triple aim: better health, lower costs and greater satisfaction.
We also look to organizations that have some successful history of improved population-based care, such as improving metrics related to preventive health or chronic disease management. We ask that all of our partners either have or be on track to receive NCQA PCMH or ACO accreditation or to be participating in a Medicare Shared Savings Program. Finally, we look for partners that provide care to at least 5,000 Cigna customers.
- Dina (@HealthPayer)