Customers benefit from improved care coordination and greater emphasis
on preventive care
Doctors are rewarded for improving patient health and lowering medical
Program includes registered nurse care coordinators aligned with Cigna
CHICAGO, July 23, 2014 - Cigna (NYSE: CI) and Presence Health Partners, a physician-led network affiliated with Presence Health, the second largest health system in Illinois, have launched a collaborative care initiative to improve patient access to health care, enhance care coordination, and achieve the goal of improved health, affordability and patient experience. The program became effective July 1 and is Cigna's second collaborative care initiative in Illinois. There are now 100 of these arrangements nationwide.
Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program will benefit the nearly 7,500 individuals covered by a Cigna health plan who receive care from more than 1,400 primary care doctors and specialists with Presence Health Partners.
In places where it’s been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while holding the line on medical costs. The programs are helping to close gaps in care, such as missed health screenings or prescription refills, reducing unnecessary use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to home.
“Our goal is to empower those we serve to achieve their best health and this initiative with Cigna is another opportunity to further that goal,” said David DiLoreto, M.D., chief clinical, quality and innovation officer for Presence Health and chief executive officer of Presence Health Partners. “By utilizing valuable data from Cigna and working as a team to coordinate care, we can improve health outcomes, especially for those with chronic illnesses or medically complex conditions.”
“We are pleased to expand our collaborative care initiative in Chicago with the addition of Presence Health Partners,” said Peter W. McCauley Sr., M.D., regional medical executive for Cigna's Northeast region, which includes the Midwest. “Our goal is to transform the health care delivery system to one focused on value instead of volume, which will lead to improved health, lower medical costs and an enhanced experience for patients.”
Under the program, Presence Health Partners will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and choose to seek care from a doctor with Presence Health Partners will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.
Critical to the program’s benefits are the registered nurse clinical care coordinators, employed by Presence Health Partners, who will help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the medical group and Cigna, which will ultimately provide a better experience for the individual.
The care coordinators will enhance care by using patient-specific data from Cigna to help 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 are part of the physician-led care team that will help patients get the follow-up care or screenings they need, identify potential complications related to medications and help prevent chronic conditions from worsening.
Care coordinators can also help patients schedule appointments, provide health education and refer patients to Cigna's clinical support programs that may be available as part of their health plan, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs for quitting smoking or managing weight.
Cigna will compensate Presence Health Partners for the medical and care coordination services doctors provide. Additionally, the medical group may be rewarded through a “pay for value” structure for meeting targets for improving quality and lowering medical costs.
Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 100 Cigna Collaborative Care arrangements with large physician groups that span 27 states, reach more than one million commercial customers and encompass more than 39,000 doctors, including more than 19,000 primary care physicians and more than 20,000 specialists.
Cigna Collaborative Care is one component of the company's approach to physician engagement for health improvement, which also includes the innovative Cigna-HealthSpring® care model for Medicare customers. Today, more than 1.3 million Cigna and Cigna-HealthSpring customers benefit from 265 engaged physician relationships across 31 states, with more than 66,000 doctors participating, including more than 25,000 primary care physicians and more than 41,000 specialists.
About Presence Health
Presence Health is the largest Catholic health system based in Illinois, created in November, 2011 through the merger of Provena Health and Resurrection Health Care. With over 150 sites of care, including 12 hospitals, Presence Health has 22,000 employees, 4,000 medical professionals and a revenue base of nearly $3 billion.
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 more than 80 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.