Cigna Plans Aggressive Expansion for ACO-like Program

In the first year, Cigna pays a care management fee based on the planned improvements. After that, rewards are based on meeting the improvement goals.

The CAC program includes a clinical collaboration component between Cigna and the physicians, so participating physicians are required to hire one embedded care coordinator for every 10,000 Cigna members in the practice.

Salmon explains that it is the job of the care coordinator to use Cigna's health informatics on hospitalizations and gaps in care to improve patient care coordination. Predictive modeling is used by the care coordinator to identify patients in the practice who might be at risk for health problems.

Care coordinators also can assess a patient's foundational knowledge of their condition. An outreach call to resolve gaps in care for a diabetic, for example, could result in the patient being referred to Cigna's diabetic coaching program to become a more active participant in their care.

In early results, Cigna says that individual CACs have outperformed their market in several areas, including avoidable emergency room visits, improved control of A1c blood sugar levels in diabetes, and reductions in the cost of ambulatory surgery. For the eight CACs that have been in place for more than one year, 50% are meeting both quality and cost goals.