As another way to help Cigna customers in Connecticut make more informed health care decisions and drive greater affordability, Cigna introduces a new orthopedic care initiative, the surgical treatment and support program, in collaboration with St. Francis Hospital, the Connecticut Joint Replacement Institute, and Southern New England Health Care Organization (SOHO HEALTH).
The initiative aims to increase transparency and help customers save by bundling payments — setting a fixed cost for an entire course of treatment — prior to receiving care. For this program, all of the care the patient needs — whether for a hip or knee replacement, or another orthopedic surgery — is covered at one fixed price, determined and known ahead of time, also known as a prospective bundle. Cigna is the first health plan to introduce prospective bundles in Connecticut.
Consider when you bundle your phone, internet and cable television services with the same provider. You’d expect that bundling to save you, well, a bundle of money, or at least some notable savings. When applied to health care, the concept is similar — customers can save money when health care services are bundled together. For example, there are maternity bundled payments for care provided prior to delivery, for the delivery itself and then for follow-up care after the baby is born.
This surgical and treatment support program applies these bundled payments to orthopedic care and prospectively informs customers of the total cost — unlike retrospective bundles, which can be unpredictable as costs are calculated post-care.
“We’re pleased to collaborate with Cigna on the new surgical and treatment support program to deliver exceptional orthopedic care in Connecticut,” said Lisa Trumble, president and chief executive officer of SOHO HEALTH. “This initiative aligns with SOHO’s commitment to serving as our region’s top value-based care network. Our providers and hospitals are recognized leaders in delivering a consistent high level of quality care at predictable costs.”
Dr. Jeffrey Langsam, Cigna medical executive for Connecticut, says that the program relies on a “high-touch concierge model” — a dedicated Cigna team that helps customers understand the program and guides them to high-performing providers.
“Our goal is to connect our customers locally to quality care at a predictable and most affordable cost, so the care is delivered in Connecticut by our participating program partners,” Dr. Langsam said.
Dr. Langsam also noted that other prospective bundled payment programs rely exclusively on ambulatory surgical centers to help drive savings. They exclude inpatient surgeries, which inflates the savings potential of those programs and can make them look more attractive.
“Cigna’s program offers the full spectrum of inpatient and ambulatory care, so the demonstrated savings are much more reliable. Our customers have access to high- quality care, often with no out-of-pocket payment, while our employer clients benefit from a more affordable, predictable cost,” Dr. Langsam said.
In many cases, depending on an individual’s plan, surgery is covered at no cost. The program also reimburses for mileage and a hotel stay in certain situations.
Cigna also offers prospective bundled payments for orthopedic care in Colorado, Florida, Missouri, North Carolina and Tennessee, and expects to bring the program to additional markets in the future.
