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Scripps, Cigna Collaboration Is All About Coordinating Care

Scripps Health has embarked on a collaboration with insurance agency Cigna Healthcare to better coordinate services between providers and patients, potentially lowering the cost of health care to employer groups.

The program, called Cigna Collaborative Care, is the company’s approach to accomplishing the same goals as Accountable Care Organizations (ACO). An ACO is a network of hospitals, doctors and other health care providers that work together to coordinate patient care.

This collaboration is between a network of Scripps health providers and Cigna and aims for the same goal of efficiency and quality care. Specifically, the program targets self-insured employer groups offering Preferred Provider Organization (PPO) plans.

“When someone with an HMO plan enrolls with a primary care physician, we authorize and pay for all of their care,” said Marc Reynolds, corporate vice president of payer relations and president of Scripps Health Plan Services. “With HMOs, we have a strong incentive and strong infrastructure to coordinate care. But in the case of PPO patients where Cigna is paying all the claims, it’s on the unmanaged end of the spectrum and we don’t see the whole picture.”

Reynolds said collaborating with payers like Cigna is a way to keep closer tabs on patient activity, which will lead to improved health outcomes, more affordability and a better patient experience.

Closing the Gaps

The program is Cigna’s first in the San Diego area, but it is one of seven in California. The collaboration began Jan. 1 and will affect 10,000 individuals covered by Cigna health plans who receive care from more than 750 Scripps primary care doctors and specialists.

In places where it’s been introduced, Cigna Collaborative Care is closing the gaps caused by PPO plans by introducing an “embedded care coordinator.” Cigna provides Scripps with funding to hire the care coordinator — usually a nurse — who is responsible for outreach to high-risk individuals. For example, a care coordinator can help patients with prescription refills, encourage preventative and follow-up health visits, help patients avoid missed health screenings and reinforce the appropriate use of emergency rooms.

Cigna provides the care coordinator with a monthly list of high-risk patients who have multiple “gaps in care,” such as medication compliance issues and multiple visits to the emergency room, so the care coordinator can reach out and rectify expensive and potentially dangerous gaps in health care.

Cigna also offers ongoing training for care coordinator nurses, and connects them with resources such as case managers, wellness coaches, behavioral coaches and pharmacists to bring their patients an expanded team of clinical resources.

Perhaps the most valuable offering Cigna brings to the collaboration is data.

“We collect data from different touch points and different providers, and we are willing to share it with Scripps,” said Gene Rapisardi, Cigna’s president and general manager for Southern California. “It’s important for a provider to know which drugs their patients are on, if they’ve been to the ER recently, etc. This data gives doctors a better holistic picture of the patient’s health.”

Financial Rewards

Under the program, Scripps Clinic and Scripps Coastal Medical Center physicians will monitor and coordinate all aspects of an individual’s medical care. Physicians may be rewarded through a “pay for value” structure for meeting targets for improving quality and lowering medical costs.

“If we do better than market average, then Cigna will reward us with financial incentives, just like Medicare does with ACOs,” Reynolds said. “But we don’t just have to pass a cost score. Cigna scores us on cost and quality of care.”

Reynolds said the main motivator for Scripps was not financial incentives. Instead, officials at the hospital system were motivated by improving the patient experience through coordinated care. As a bonus, the coordinated care usually costs less.

“But this savings isn’t really Scripps’ money — it’s not even Cigna’s money,” Reynolds said. “It’s Cigna’s customers who save money. Self-insured employers are the majority of Cigna’s business. This is a competitive pressure. They’re thinking, ‘if we don’t take care of our members, somebody will replace us.’”

Rapisardi agrees the collaborative care programs are a competitive move.

“You can’t be the status quo in this health care environment,” Rapisardi said. “Health care is transforming, and we have to change with it.”

Despite the program’s similarities to the Affordable Care Act (ACA) initiative to form Accountable Care Organizations, Rapisardi said this program predates the ACA.

“We began this in 2008,” Rapisardi said. “We now have 114 of these collaborative care programs nationwide.”

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