Cigna looks for physician groups that have already worked for several years on improving traditional quality metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and are prepared to take on the bigger issue of improving broad, population-based metrics through care coordination. "Cigna becomes the payer partner that helps make that effort financially sensible and rewarding," says Salmon.
He adds that "a large multispecialty group that only cares about fee-for-service generation isn't going to be a good partner for us in this."
CAC contracts are typically for three years and are customized to reflect the improvement goals of individual physician groups. Goals are usually based on the extensive practice profiles and data maintained by Cigna.
For example, data might indicate that a group has a high rate of emergency department visits. The action plan developed to reduce the rate of visits would reflect the preferences of the physician group, which could include making more urgent care appointments available throughout the day, as well as adding evening and weekend office hours.