Novant Health Inc. is riding the accountable-care wave by agreeing to an initiative with Cigna that affects more than 60,000 Cigna customers in the Carolinas. The program begins April 1.
Accountable-care organization (ACO) programs are part of a shift from a traditional fee-for-service model to one that focuses on early intervention and closer monitoring of patients with chronic diseases and the quality of care provided.
The goal for ACOs is to coordinate among hospitals, doctors, rehabilitation centers and other providers to eliminate duplicate procedures, prevent medical errors and keep patients healthier.
Patients most likely to see the immediate benefits of the program are those who need help managing such chronic conditions as diabetes or heart disease.
Cornerstone Healthcare signed a similar ACO partnership with Cigna in April 2012, as well as one with United Healthcare in January. Cigna said it has four ACO collaborations in the Carolinas, with the effort with Novant being its largest nationally.
Novant and Wake Forest Baptist Medical Center are engaged in similar patient-centered medical home (PCMH) strategies that have an overarching goal of reducing health-care costs.
The effort could help raise Cigna’s profile in the Triad and Carolinas. It typically trails Blue Cross Blue Shield of N.C., United Healthcare and Aetna in market share in many N.C. markets, according to annual American Medical Association reports.
“A patient-centered system that’s focused on prevention and wellness, combined with the right incentives for physicians, will ultimately result in a healthier population and lower medical costs,” said Dr. Edward Hunsinger, Cigna’s senior medical director for the Carolinas.
Carl Armato, chief executive of Novant, said the health-care system considers the Cigna initiative as complementary to the efforts of its Novant Medical Group practices that are certified as PCMH facilities by the National Committee for Quality Assurance.
Bob Seehausen, Novant’s senior vice president for business development and sales, said the center is talking to every insurer about aligning incentives around the ACO concept.
“Virtually every payor arrangement we have in place has incentives to measure and improve performance, though the CIGNA program is the most comprehensive to date,” Seehausen said.
Under the program, Novant registered nurses will have the primary responsibility of monitoring and coordinating aspects of an individual’s medical care, with patients continuing to go to their current physician.
Many patients using Novant Health Medical Group physicians will be managed using the Epic electronic medical record system and have access to My Chart, an electronic patient access tool that enables patients to communicate with their care team and review medical records online.
Novant’s care coordinators will work with Cigna case managers in the initiative.
Changing the health care system is rarely simple, and the PCMH concept faces challenges.
It’s more expensive to reach out to patients and manage their care, and whether private insurers and employers will help pay for the new model is undetermined. Primary-care physicians, the core of the concept, are in short supply.
Cigna said it will compensate Novant for the medical and care coordination services it provides. The medical group may be rewarded through a “pay for value” structure if it meets targets for improving quality and lowering medical costs.
The PCMH initiative began within Medicaid, the state and federal program that provides health care for low-income or disabled people. In return for the extra services, the state Medicaid program is paying $3 a Medicaid patient to the local Community Care of N.C. network and $2.50 to the primary-care practice. Physicians are reimbursed through the practice. The expectation is that patients’ co-pays eventually will be lower if they go to a PCMH physician and practice.
Pam Duncan, director of innovations and transitional outcomes at Wake Forest Baptist, said the system is working with Community Care of N.C. to unveil an initiative aimed at Medicare and Medicaid patients who frequently use the hospital, particularly its emergency department, for primary care needs. A parallel initiative will work with CenterPoint Human Service on preventive mental-health services.
The initiative begins this spring with 400 patients identified as having complex health-care needs through the Community Care network and Wake Forest Baptist’s patient records. Duncan said most of the patients have a primary-care physician.