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Insurer's Reimbursement Model Rewards Lower Costs

Rene Letourneau, for HealthLeaders Media, July 8, 2013

As value-based purchasing takes shape, some commercial insurers are offering incentives designed to reward provider organizations for improved outcomes and decreased overall costs.    

Through its Collaborative Accountable Care (CAC) initiative, Bloomfield, CT-based insurance giant Cigna is partnering with hospitals and medical practices that have a substantial primary care component to restructure reimbursements.

"The ultimate goal is to achieve the triple aim for the individual patient, which is better quality, better affordability, and a better overall healthcare experience. We believe the best way to do that is to make sure incentives for healthcare professionals are aligned," says Richard Salmon, MD, PhD, Cigna's national medical executive, performance measurement and improvement.

When a group joins the CAC program, Cigna pays an initial fee of $1.50 for each of its members who receive care at the practice. The money is typically used to hire registered nurses as clinical care coordinators to help patients with chronic conditions or other health challenges navigate the healthcare system.

Cigna continually provides the care coordinators with a list of patients who are about to be discharged from the hospital so they can make outbound calls to assist patients with understanding their medications and scheduling follow-up appointments with their primary care physicians.

Additionally, Cigna supplies a monthly list of patients who are considered to be "at risk," such as patients with a chronic illness who have long gaps in care and patients who have used the ED more than once in a short time frame.

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