Cigna wants more value-based reimbursements for systems treating at-risk patients

Cigna's plan for improving healthcare quality and reducing waste involves meeting at-risk patients where they seek care and giving health systems incentives for improving the health of those patients.

The goal, according to Alan Muney, M.D., chief medical officer and senior vice president of Cigna's Total Health and Network division, is to have a "large majority" of Cigna's at-risk customers seeing physicians with whom the insurer has an incentive relationship.

In a session Wednesday at the Healthcare Information and Management Systems Society's annual conference in Chicago, Muney outlined Cigna's three approaches to Cigna's value-based reimbursement structures.

  • Cigna believes that accountable care organizations can help deliver population health, and the payer currently has more than 100 ACO relationships with providers, Muney said.
  • Cigna's growing bundles payment model focuses on flexibility so that providers can accept the level of risk that makes the most sense for them.
  • So-called "delivery system alliances" emphasize the shift from volume to value. Many begin with the hospitals' employees before extending into the community, Muney said. But this transformation can only occur as quickly as providers and employers are ready to make the shift.

These new reimbursement structures depend on innovative approaches to care, which range from data on patient outcomes used at the point of care to smarter narrow networks that emphasize quality and transparency on top of low costs. The goal, Muney said, is a more connected and interoperable healthcare system that's better equipped to give patients the information they need to make the best care decisions.

This will take time, Muney admitted. But consumers cannot wait, he added, and they will choose the care system that's most convenient to them. Increasingly, that's a retail clinic or telemedicine doctor as opposed to a primary care physician.

Consumers want affordability and personalization, Muney said--and they will vote with their feet, opting for the organizations that get consumer engagement right.

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