Yesterday, CIGNA announced the launch of an accountable care organization (ACO) pilot with the Piedmont Physicians Group in Atlanta, Georgia. The essential intention behind this pilot is to demonstrate how primary care physicians can be rewarded for improving outcomes while also having lower medical costs.
The pilot program will monitor and coordinate ALL aspects of patient care. Patients will not have to do or change anything in this pilot. All of the adjustments will be done internally. Patients will most likely experience immediate benefits in the management of chronic conditions, such as diabetes.
The CIGNA/ Piedmont pilot uses a registered nurse as the clinical care coordinator. This role is specifically oriented to assist patients as they navigate through the healthcare system to manage their health issues. The care coordinator adds an additional layer of interface that will use data and clinical programs to help support the individual’s needs. The focus will be on improved outcomes.
In essence, this program, and others like it, are going back to basics on one level and moving forward on another. The focus will be on prevention – keep an individual well but once the individual needs to access care, the pilot will work to coordinate that care, guiding the patient through the process with knowledge and informing data.
CIGNA will continue to pay the primary care physicians for the medical services they provide but they will also pay a care coordination fee along with a possible reward in a pay for performance structure. In some ways, this is similar to concierge practices where the physician continues to provide medical services for reimbursement from third party payers but also collects an annual fee for additional services – services not unlike care coordination and an emphasis on prevention. The responsibility for that additional fee becomes the payer’s in exchange for improved outcomes. Sounds like a win-win situation.
Providers need to make way for new incentive programs like this one. Whether a hospital or a physician organization, preparation for change needs to happen now. There is substantial information flowing about electronic health records (EHRs), utilization of outcomes data and comparative effectiveness research findings and the ability to provide care coordination. It is likely that these three tenants will form the basis of a provider’s ability to become an ACO.
The handwriting on the wall indicates that providers will be paid for keeping patients healthy. Providers should reconsider the value of their outreach programs that seek to motivate physical activity, healthier diets and smoking cessation. Some early research (Trust for American’s Health, 2008) suggests that funds spent on prevention outreach lead to significant savings in healthcare costs. This kind of outreach is already in place in many organizations. If not, the easiest step is to focus on wellness events and early detection programs and begin planning for the other steps (EHR implementation, using comparative effectiveness research findings and coordination of care). The world is changing and providers need to change along with these new (or renewed) constructs.
