Newsroom | 10 June 2008

Cigna and Dartmouth-Hitchcock Launch 'Patient-Centered Medical Home' Program to Provide Better Care Coordination


Mark Slitt
Melissa Mashaw-Gomeau


BLOOMFIELD, Conn. & LEBANON, N.H., June 10, 2008 - Cigna and Dartmouth-Hitchcock today announced they have launched a "patient-centered medical home" pilot program, with the goal of further enhancing the coordination of care and improving care quality for patients covered by a Cigna plan. The program is focused on individuals who receive care from Dartmouth-Hitchcock primary care physicians practicing in family medicine, internal medicine and pediatrics. Currently, approximately 19,000 Cigna members access care from a Dartmouth-Hitchcock primary care physician.

The patient-centered medical home model of care is designed to provide patients with a comprehensive, coordinated approach to primary care which in turn leads to improved quality and lower medical costs. In the pilot, patients, especially those with chronic illness or ongoing medical needs, will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system, while physicians will receive additional reimbursement for providing these enhanced services and supportive infrastructure. Dartmouth-Hitchcock has a tradition of pursuing these objectives; both organizations say the new pilot program will help to accelerate existing efforts.

"Our health care system is increasingly complex and disjointed, and the traditional physician payment structure rewards specialization and providing more care, rather than rewarding more coordinated care," said Dr. Dick Salmon, national medical director for Cigna, himself a primary care physician. "The patient-centered medical home model is a promising approach to changing both of these dynamics while preserving primary care medicine, and we are pleased to be working with an organization like Dartmouth-Hitchcock, which has already implemented many patient-centered medical home features in its practice, to further develop the model."

"As health care continues to evolve, we are seeing a greater need to improve community health through the transformation of patient care to meet the unique and changing needs of the patients we serve," said Dr. Barbara Walters, senior medical director, Dartmouth-Hitchcock. "Our partnership with Cigna to pilot the patient-centered medical home program exemplifies our ongoing mission to achieve the healthiest population by providing each person with the best care, at the right time, every time, as well as our organizations working together to set the standard for this new model of patient care."

Members will simply access care from one of the 391 Dartmouth-Hitchcock primary care providers participating in the pilot. There is no change in choice of primary care provider or in any plan requirements regarding referrals to see specialists.

Primary care providers affiliated with Dartmouth-Hitchcock will be paid for the medical services they provide, reimbursed an additional amount for enhanced services such as care management they provide and be rewarded through a "pay for performance" structure for improving quality and appropriate health care. Salmon said that emphasizing the value of the primary care physician as the overall coordinator of the health of their patients will help increase the professional satisfaction and financial rewards for doctors who practice in primary care.

Dr. Paul Grundy, chairman of the Washington, D.C.-based Patient-Centered Primary Care Collaborative, and director of Healthcare Technology and Strategic Initiatives at IBM, said this is a truly groundbreaking pilot program. Implemented by a commercial payer and a physician practice, it is based on a sustainable economic model that employers can adopt with confidence.

"We expect the increase in up-front fees for patient care coordination will be offset by future improvements in quality and lower total medical costs," Grundy said. "This is especially important, because health plans and employers alike have been reluctant to increase payments without any promise of measurable improvements in both quality and total costs of care."

The program, one of the first medical home pilots being established by a private-sector health service company, will be an ongoing initiative. The first evaluation of program results will take place after the program has been operational for at least 12 months. The pilot is intended to help Cigna gather additional data about the effectiveness of this model in improving quality of care, improving patient satisfaction and reducing medical costs.

Dartmouth-Hitchcock is currently participating in a Centers for Medicare and Medicaid Services (CMS) Group Physician Practice demonstration project, which allows it to develop the necessary capabilities to participate in this pilot, including case management, enhanced access and information-driven care. Dartmouth-Hitchcock is also applying for the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home designation.

About Cigna HealthCare

Cigna HealthCare, a health service organization based in Bloomfield, Conn., works to improve the health, well-being and security of the people we serve. A leading provider of employee benefit services and programs, Cigna HealthCare offers a broad array of medical, dental, behavioral health, and pharmacy benefits plans and coverage. We also build and provide health and wellness coaching programs and consumer information tools designed to improve health and help people in their health care decision-making. "Cigna HealthCare" and the "Tree of Life" logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation (NYSE:CI) and its operating subsidiaries, including Connecticut General Life Insurance Company. All products and services are provided exclusively by such operating subsidiaries, and not by Cigna Corporation. For more information, visit

About Dartmouth-Hitchcock

Dartmouth-Hitchcock has physician group practices throughout New Hampshire, and is part of the Dartmouth-Hitchcock Medical Center, a charitable, non-profit organization based in Lebanon, N.H. DHMC includes Mary Hitchcock Memorial Hospital, the VA Hospital in White River Junction, Vt., Dartmouth Medical School, and Dartmouth-Hitchcock Clinic, a multi-specialty academic group practice. For more information, visit