Plano-based Village Health Partners is the latest North Texas physician practice to join Cigna’s collaborative accountable care effort.
Cigna’s CAC program is designed to help physician practices to achieve the same population health goals of accountable care organizations. The program will include Cigna patients treated by a VHP physician. VHP, which treats more than 50,000 North Texas patients, recently announced that it added a second Plano location.
The VHP program 4 is Cigna’s third such collaboration in North Texas and its sixth in the state.
VHP clinical care coordinators will help patients with chronic conditions schedule appointments, provide health education and navigate the healthcare system. The care coordinators will work with Cigna case managers to ensure collaboration.
Cigna’s predictive modeling data helps identify patients being discharged from the hospital who might be at risk for readmission, and other patients who may be overdue for health screenings or who may have skipped a prescription refill. Practice coordinators also can refer patients to Cigna’s clinical programs, such as disease management programs for diabetes and heart disease, and lifestyle programs, including tobacco cessation, weight management and stress management. Cigna research shows that referral to the programs by the physician practice improves patient engagement because the doctor or care coordinator is seen as a trusted adviser.
In addition to reimbursement for medical and care coordination, Cigna may pay VHP performance incentives if it meets targets for improving quality and lowering medical costs.
VHP co-founder Christopher Crow, MD, said he expects about 85 percent of his patients to be under a medical home contract by this summer. He said VHP has similar contracts with Aetna and Blue Cross Blue Shield of Texas.
Crow said the contracts are similar philosophically and focus on three main goals: transitions of care, gaps in evidence-based care, and identifying and following patients at high risk for medical costs.
He said the Cigna contract would allow him to hire the practice’s third care coordinator. The contracts also have allowed VHP to bolster allied health and information technology staffing for greater efficiency and effectiveness, Crow said.
Frederick Watson, MD, Cigna’s senior medical director for North Texas, called VHP “an incredibly forward-look group. They have really been focused on quality over a number of years even when health plans didn’t give incentives. That exactly what we look for (in contract partners).”
Watson said CAC program members generally have at least 2,500 Cigna patients and are certified by the National Committee for Quality Assurance.
Cigna uses patient-centered medical home principles as the foundation for CAC. Company officials say they are trying to achieve the “triple aim”, promoted by former Centers for Medicare and Medicaid Director Donald Berwick, of improved health outcomes, affordability and patient satisfaction.
The company has 52 CAC initiatives in 22 states. The program nationally includes more than 500,000 Cigna customers and more than 14,000 doctors, including more than 6,500 primary care physicians and more than 7,500 specialists. Cigna, which began the program in 2008, hopes to have 100 CAC initiatives covering one million customers by the end of 2014.
One of Cigna’s earliest pilot projects was at Medical Clinic of North Texas (MCNT), based in North Richland Hills. The MCNT program, mentioned in a November Health Affairs article, improved control of A1c blood sugar, cholesterol and blood pressure levels in diabetes patients, outperformed the market by 7 percent for avoidable emergency room visits, and lowered the hospital readmission rate of its patients by 2 percentage points. MCNT was able to lower expected costs by $6.56 per patient per month. The company merged with Irving-based USMD Holdings Inc. in September.
Cigna also launched the program with Baylor’s HealthTexas Provider Network in April, covering 7,000 patients.
Watson said Cigna has seen consistent improvement in quality and costs in CAC program participants, some of which have exceeded MCNT’s performance.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.