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Doctors Feel Pressure to Accept Risk-based Reimbursement

Jacqueline Fellows, for HealthLeaders Media, July 24, 2014

As insurers step up efforts to cover more lives with value- and performance-based contracts, physicians are under the gun to adapt to an altered reimbursement reality.

Cigna has met its goal of covering 1 million healthcare consumers under its quality and performance-based reimbursement model called Collaborative Accountable Care (CAC) arrangements, the insurer announced this month.

The Bloomfield, Connecticut-based payer has 100 such arrangements with large physicians groups in 27 states. Cigna's National Medical Executive for Performance Measurement and Improvement, Dick Salmon, MD, says large groups were targeted because they had the resources, organization, and capabilities to manage population health.

"Since 2008, we have been focusing on large physician-led organizations, including multispecialty groups, primary care groups, IPAs and the physician leadership in integrated delivery systems and PHOs," says Salmon.

"However, our research indicates that just 20% of customers with high cost conditions or complex needs receive care from a large physician-led organization, so we know that focusing on just large physician groups isn't enough."

Salmon says Cigna has expanded its reach to include smaller physician groups with small "test-and-learn" pilot projects in select markets.

Cigna is not the only large insurer refining its reimbursement approach to accommodate a value-based healthcare system. Aetna, Humana, UnitedHealth, and others are aggressively pursuing strategies that pay providers based on quality and cost-containment.

What's in a Name?
These risk-sharing agreements are called various things from accountable care organizations to bundled payment initiatives. And while the range of reimbursement models do have some important differences, the thread that unites them all is rewarding for improvement in health outcomes and costs.

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