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Cigna and Memorial Sloan Kettering Cancer Center have formed a value-based-care arrangement that will allow the cancer hospital to earn shared-savings payments if it meets certain cost and quality goals.
The agreement, which covers people with employer-sponsored plans, is part of Cigna Collaborative Care, a value-based model the insurer started in 2008 that now has about 250 participants. Cigna began working with oncology providers through the program in 2015.
With the program, patients get a registered nurse to coordinate their treatment with Cigna. These nurses have a single point of contact at Cigna to resolve benefits issues.
“Nurses are on the front lines of day-to-day cancer care, so coordinating patient care through a dedicated nurse offers opportunities to improve and streamline the high-quality, patient-centric care we already provide to our patients,” Elizabeth Nelkin McCormick, senior vice president and chief nursing officer at MSK, said in a statement.
Cigna also provides care-management services to educate patients about treatment options, the cost of services and potential side effects. Members have 24/7 access to a clinician affiliated with the practice.
One of Cigna’s goals is to prevent patients from taking an unnecessary trip to the hospital because of the side effects of their treatment. It also aims to have MSK engage the patient upon discharge if a patient is admitted to a different hospital.
“We let them know when those customers get hospitalized. They may get admitted somewhere else and the provider is not aware of that,” said Dr. Bhuvana Sagar, Cigna’s national medical executive. “They can outreach to the customer and ensure they get the right care. A lot of these are simple things. They can drive change.”
Other local participants in Cigna Collaborative Care for oncology include NYUPN, a clinically integrated network that combines NYU Langone Health and University Physicians Network, and Regional Cancer Care Associates in New Jersey.
There are 25 provider organizations in New York and New Jersey participating in Cigna Collaborative Care for large physician groups.
Providers receive an upfront care-coordination fee for participating in the program. Each year their costs are measured against either a national benchmark or their own baseline. If they save Cigna a greater amount of money than the initial care-coordination fee, the provider can share in the savings. Participants also must meet certain goals based on the quality of care to receive a payment.
“It’s an open-book test. We share information throughout the year. There are no surprises,” said Dr. Ron Menzin, senior medical director for Cigna’s New York and New Jersey market. “We hope these groups succeed and want them to succeed.”
Providers aren’t penalized if patients’ costs are higher than expected.
“The goal is to improve quality,” Sagar said. “Risk can be a bad four-letter word.” —Jonathan LaMantia
Date: July 26, 2019
Source: Crain’s New York Business