Accountable Care Organizations are one of the many avenues that healthcare reform is taking. They are growing in popularity and some health insurance carriers are taking the initiative to create their own ACO-style healthcare systems for some of their members. Earlier this year I wrote about Anthem Blue Cross Blue Shield’s new medical home program in Colorado. Now Cigna is expanding their version of an accountable care program in several states. In Colorado, Cigna’s collaborative accountable care program will be run in cooperation with Colorado Springs Health Partners (CSHP). CSHP has an ambulatory surgery center and ten medical offices in the Colorado Springs area, as well as an urgent care clinic. They have more than a hundred physicians who can provide more than twenty specialties – they’s a significant part of the medical provider community in southern Colorado.
The collaboration between Cigna and CSHP will focus on improving patient outcomes, making healthcare more accessible and affordable, and improving patient satisfaction. One of the key components of the Cigna program is registered nurses working at the medical offices who will serve as care coordinators. These care coordinators will follow up with recently hospitalized patients to try to avoid preventable re-hospitalizations (costly and definitely not likely to result in a satisfied patient). They will also work with patients who have chronic illnesses to make sure the patients are filling their prescriptions, receiving needed office visits and screenings, and getting referrals to disease management programs that could help to prevent the conditions from worsening. The hands-on approach that the medical offices will be taking is likely to result in fewer re-hospitalizations and better overall compliance with medical advice.
Hopefully the program will also provide guidance for patients who aren’t filling prescriptions because they cannot afford to do so (for example, a referral to pharmaceutical company programs that provide free medications to people who can’t afford them), and help to address issues like lack of transportation or inability to fit medical office visits into inflexible work schedules. Some people truly just need a reminder to go get a screening test or refill a prescription. Others have more significant obstacles preventing them from doing so.
CSHP also works with most of the other major health insurance carriers in Colorado, although it’s notable that they don’t accept CHP+. And like many providers, they have limited availability for patients with Medicare or Medicaid.
Cigna has already established their collaborative accountable care programs with provider groups in other states and the success of those programs is what’s driving the expansion into ten more states, including the collaboration with CSHP. Hopefully the program will continue to be successful in the new locations, resulting in better patient outcomes, more accessible and affordable healthcare, and better patient satisfaction. I would also expect to see more of this sort of collaboration between health insurance carriers and healthcare provider groups as time goes on.