Health Care Reform Today

• Alan Muney, M.D.
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  Alan Muney, M.D.

  

  Alan Muney, M.D.

  Chief Medical Officer (CMO)

Improving the quality of health care is an important goal of health care reform. One of the ways the Patient Protection and Affordable Care Act (PPACA) seeks to do that is through Accountable Care Organizations (ACOs).

ACOs are groups of primary care doctors, specialists and hospital systems that agree to take responsibility for providing or coordinating all their patients' care for a fixed fee. The goal of ACOs is to improve quality while holding down costs.

Last December, the Department of Health and Human Services (HHS) announced the introduction of 32 new ACOs that provide care for Medicare patients. These ACOs were considered some of the first, even though Cigna has been creating accountable care programs in the private sector since 2008.

At Cigna, our Collaborative Accountable Care initiatives are designed to deliver the right care at the right time in the right place and reward health care professionals for achieving the "triple aim" – improving quality (clinical outcomes), affordability (lower medical costs) and patient satisfaction. We go beyond the traditional payer role and actively collaborate with medical groups to assist them in achieving these goals by providing them with actionable information and access to additional care coordination resources for their patients.

As of February 1st, Cigna is currently engaged in 16 Collaborative Accountable Care initiatives in 10 states, including over 235,000 Cigna customers and more than 3,350 doctors (over 2,000 primary care physicians and 1,300 specialists). This month, we launched our latest location in Kennebec, ME. With 18 additional sites scheduled for 2012, we are well on our way to achieving our goal of implementing 100 collaborative accountable care initiatives by 2014.

We believe this approach can help transform the way medicine is practiced – from a system focused on reactive treatment of illness and rewarding doctors for volume to one that's proactive, patient-centered and emphasizes prevention and primary care. By changing the payment system to align incentives with outcomes, we are partnering with doctors to better coordinate patient care and improve quality.

Under our accountable care model, patients continue to see their current doctors. They don't need to do anything different to receive all the advantages of the program. The patients most likely to benefit are those who need help managing chronic conditions such as diabetes or heart disease.

Registered nurses who work for the medical group serve as embedded care coordinators and reach out to patients to help them manage their health by performing a number of activities. These include: identifying patients discharged from the hospital who might be at risk for readmission, contacting patients who are overdue for important health screenings or who have missed a prescription refill and referring patients to Cigna's disease management and health coaching programs. Providing health education and helping patients manage their care is another important component of our model.

Cigna's accountable care initiatives are targeted to group health plans offered by employers because we know that employers are looking for ways to lower costs by improving the health of their employees. Some of our early results include a 10% increase in closure of "gaps in care", and a 2% reduction in medical cost trend compared to market average. Based on our experience with these programs so far, we believe that better collaboration between health plans and doctors is resulting in healthier individuals and lower medical costs.

Please visit our Accountable Care Organization website to keep current on our progress in this important realm.