Newsroom | 11 December 2013

Granite Healthcare Network Shows Higher Quality, Lower Costs in Collaborative Accountable Care Program With Cigna


Mark Slitt
Granite Healthcare Network
Rachel Rowe

  • Quality score improved, now better than New Hampshire market
  • Better-than-market quality results for cancer screenings, diabetes care, adolescent well care
  • Improvements in closing gaps in care
  • Medical cost trend was 1.2 percentage points better than New Hampshire market

CONCORD, N.H. & BLOOMFIELD, Conn., December 11, 2013 - First-year results from Cigna's (NYSE:CI) collaborative accountable care initiative with Granite Healthcare Network (GHN), a partnership among five independent charitable health care organizations in New Hampshire, indicate that the program is making strides toward achieving its goals of improved health, affordability and patient experience. The initiative has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its 30,000 patients who are covered by a Cigna health plan.

The Granite Healthcare Network comprises Concord Hospital, Elliot Health System, LRGHealthcare, Southern New Hampshire Health System and Wentworth-Douglass Hospital. Each member is an independent, integrated health care delivery system consisting of primary care doctors, specialists and hospitals. Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations, or ACOs.

When the program started last year, Cigna evaluated how well GHN followed nationally recognized evidence based medicine guidelines (a measure of quality) and determined that GHN's performance was at parity with the New Hampshire market. In just one year, GHN has improved those quality results one percent and is now better than the market. This was driven by improvements in a number of quality measures, including better-than-market quality results for cervical and breast cancer screening, adolescent well care, diabetes care and child access to primary care doctors. In addition, during the first year of the initiative, GHN improved its rate for closing gaps in care by two percent.

During the year, GHN's medical cost trend was 1.2 percentage points better than the New Hampshire market (GHN 3.7 percent, market 4.9 percent). This successful bending of the cost curve was driven by a number of factors, including:

  • Emergency room cost trend reduced by 8 percent
  • Emergency room use reduced by 4 percent
  • Advanced imaging (MRI and CT) cost trend reduced by 4 percent
  • Advanced imaging (MRI and CT) use reduced by 7 percent

Very often, patients seek emergency room care when their condition isn't an emergency, which drives up the cost of care. Through expanded office hours and patient education, emergency room use and cost decrease when patients receive care in the most appropriate setting, such as at the doctor's office or an urgent care center.

"We are extremely proud of the dedicated efforts of our medical directors and physician practices across the region to deliver a higher level of care to the residents of our communities. Our collaboration with Cigna, which has been a leader in accountable care in New England and throughout the country, is helping us deliver high quality care while keeping health care costs in check," said Rachel Rowe, executive director for the Granite Healthcare Network. "While we're very pleased with the progress we've made so far, we look forward to continuing the collaboration to the benefit of our patients and Cigna's customers."

"These remarkable results show that shifting to a system that's focused on value rather than volume of care is a viable path to improved health and lower medical costs, which is good for all stakeholders - individuals and their families, employers, and the medical community," said Donald Curry, president and general manager for Cigna in New England. "They also show what can be accomplished when a health plan and a health care delivery system work together with common goals."

Each of the GHN-participating organizations monitors and coordinates all aspects of an individual's medical care. Critical to the program's benefits are registered nurses, employed by each of the five GHN health care organizations, who serve as clinical care coordinators and are integrated into the care delivery team to help patients with chronic conditions or other health challenges navigate their health care system. The care coordinators enhance care by using patient-specific data provided by Cigna and the electronic medical record to identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators also help patients schedule appointments, provide health education and refer patients to specialized clinical programs, such as chronic condition management programs for diabetes, heart disease and other conditions; and programs that help people quit tobacco cessation, control their weight or manage stress. More than 30 care coordinators across GHN have completed specialized training from Johns Hopkins University as Guided Care Nurses, setting these five health systems apart from other medical groups across the country.

Cigna provides some compensation to GHN for the medical and care coordination services its participating organizations provide. Additionally, the organizations are rewarded through a "pay for value" structure if they meet their targets for improving quality and lowering medical costs. Employers who sponsor health plans benefit from lower health care costs or health care costs that increase at lower rates.

The principles of the patient-centered medical home have been adopted by GHN's more than 150 physician practices and are the foundation of Cigna's collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with physician practices. Cigna has 75 collaborative accountable care initiatives in 26 states, encompassing more than 760,000 commercial customers and more than 30,000 doctors, including more than 14,000 primary care physicians and more than 16,500 specialists. Cigna launched its first collaborative accountable care program in 2008 and its goal is to have 100 of them in place with one million customers in 2014.

Collaborative accountable care is one component of the company's approach to physician engagement for health improvement, which also includes the innovative Cigna-HealthSpringSM care model for Medicare customers. Today, well over one million Cigna and Cigna-HealthSpring customers benefit from 240 engaged physician relationships across 31 states, with more than 58,000 doctors participating, including more than 20,000 primary care physicians and nearly 38,000 specialists.

In New England, Cigna has collaborative accountable care arrangements in Connecticut with Day Kimball Healthcare, New Haven Community Medical Group, ProHealth Physicians, Inc., Saint Francis HealthCare Partners and several others that will be announced soon; in Maine with Central and Western Maine Regional PHO, Kennebec Region Health Alliance, Martin's Point Health Care, Mercy Health System and Penobscot Community Health Care; in Massachusetts with Baycare Health Partners; in New Hampshire with Dartmouth-Hitchcock Clinic and Derry Medical Center; and in Vermont with Fletcher Allen Health Care.

About Cigna

Cigna Corporation (NYSE:CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has approximately 80 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit

About Granite Healthcare Network (GHN)

GHN is a network of charitable organizations that are leading the transformation of healthcare delivery in New Hampshire by leveraging their collective intellectual and clinical resources to improve quality, cost-effectiveness and access beyond what any one of them could achieve individually. The member hospitals - Concord HospitalElliot Health SystemLRGHealthcareSouthern New Hampshire Health System, and Wentworth-Douglass Hospital - have joined forces to implement innovative initiatives focused on the triple aim of providing better health for communities and better care for patients at an affordable cost.