Cigna and Summit Medical Group today announced the launch of a “collaborative accountable care” program, where the insurer will pay Summit to coordinate patient care, then share with Summit some of the money it expects to save through improved health outcomes for the 10,000 Cigna members who belong to the medical group.
Berkeley Heights-based Summit, with more than 300 doctors at 20 locations around New Jersey, has put emphasis on the use of electronic medical records, focusing on preventive care and deploying care coordinators who monitor patients with chronic conditions.
Dr. Jeffrey Le Benger, chief executive of Summit, said the partnership “is a shared advantage, meaning that if we show certain quality measures, and if we show how we save dollars, then we will get a few more dollars per patient, per month,” from Cigna. He said Summit is talking to all the major health plans in New Jersey about compensation models that incentivize a more efficient use of health care resources.
“We think the market is going to move toward shared value, (and away from) fee-for-service,” Le Benger said. Right now, the overwhelming majority of U.S. health care providers get paid a fee for everything they do, creating incentives to provide more care, regardless of its benefits. In the new accountable-care world, “We need to justify savings in the medical field, such as hospital visits, emergency room use, length of stay, readmission rates,” Le Benger said.
Summit says its hospital readmission rates are much lower than average, in part because its hospitalists, — Summit clinicians working at hospitals — “do not get paid fee-for-service — they get paid for quality metrics, like decreasing the length of stay and decreasing readmissions,” Le Benger said. The hospitalist, he added, “is like a quarterback: they bring in the specialists the patient needs, and arrange for post-hospital care.”
Dr. Dan Nicoll, Cigna regional medical executive, said the program will enable Summit to provide more health care resources to Cigna members.
“Cigna has very good information systems, and we have very good programs to help people, whether it is with weight loss, smoking cessation, or difficulty with diabetes or asthma,” he said.
Cigna has 12 million members nationwide, including 430,000 in New Jersey, and has set a goal by 2014 to have 100 accountable-care programs nationwide, covering 1 million of its members. Nicoll said these programs will grow because “people are going to vote with their feet. When they realize there is this level of support, that is going to cause patient migration to these practices.” And, he said, “for physicians who are not part of these relationships, it is going to put competitive pressure on them to join these relationships, so they can deliver that higher level of coordinated care to their patients.”
He said the money to pay Summit for care coordination “will come out of the decreased costs associated with fewer complications and a healthier population, such as the asthmatic who doesn’t need to go to the ER. We want to reduce services that are avoidable, complications that are avoidable, and share those savings with the doctors.”