Affiliation will improve health care and lower costs.
By Roxanne Moster, UCLA
UCLA Medical Group and Cigna have launched a collaborative care initiative to improve patients’ access to health care, enhance care coordination and achieve the goals of improved health, affordability and patient experience.
“This new affiliation provides us with an important framework in our mission to provide accountable, better coordinated patient care,” said Dr. Samuel A. Skootsky, chief medical officer of the UCLA Faculty Practice and UCLA Medical Group. “UCLA Health System has developed an innovative model of primary care to improve care coordination and provide needed services for our patients, in addition to providing exemplary specialty care. This partnership allows us to take this enhanced approach to health care for Cigna’s PPO patient population — focusing on high-value, high-quality care that is truly patient-centered and puts patients first.”
The UCLA Medical Group comprises more than 1,200 physicians who are clinical faculty members at the David Geffen School of Medicine at UCLA. They provide primary and specialty medical care at over 100 ambulatory locations as well as at the Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA, UCLA Medical Center–Santa Monica and the Resnick Neuropsychiatric Hospital at UCLA.
Under the program, UCLA physicians will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to see their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a UCLA doctor also will have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.
Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program, which began Jan. 1, will benefit more than 5,900 people covered by a Cigna health plan who receive care from more than 1,600 UCLA primary care doctors and specialists. Cigna now has seven collaborative care arrangements in California and 114 of them nationwide.
In places where it has been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while effectively managing medical costs. The programs are helping to close gaps in care, such as missed health screenings or prescription refills, reinforcing the appropriate use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to the home.
“Together our goal is to change the health care system from one that pays for the number or volume of services to one that places more emphasis on the quality and results of that care,” said Gene Rapisardi, president and general manager for Cigna in Southern California. “We believe this change will lead to better health, lower costs and increased satisfaction for both our customers and their doctors.”
Critical to the program’s benefits is a UCLA care coordination system based on in-office care coordinators and registered nurse clinical advisors, employed by UCLA, who will help patients navigate the health care delivery system. The care coordinators and clinical advisors are aligned with a team of Cigna case managers to ensure a high degree of collaboration between UCLA physicians and Cigna, which will ultimately provide a better experience for the individual.
The UCLA care coordinator team will enhance care by using patient-specific data from Cigna to help identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators are part of the physician-led care team that will help patients get the follow-up care or screenings they need.
Care coordinators can also help people schedule appointments, provide health education and refer patients to Cigna’s clinical support programs that may be available as part of their health plan, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs for quitting smoking or managing weight.
Cigna will compensate UCLA physicians for the medical and care coordination services they provide. Additionally, physicians may be rewarded through a “pay for value” structure for meeting targets for improving quality of care and lowering medical costs.
Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 114 Cigna Collaborative Care arrangements with large physician groups that span 28 states, reach more than 1.2 million commercial customers and encompass more than 48,000 doctors, including more than 23,000 primary care physicians and more than 25,000 specialists.
Cigna Collaborative Care is one component of the company’s approach to physician engagement for health improvement, which also includes the innovative Cigna–HealthSpring care model for Medicare customers. Today, more than 1.5 million Cigna and Cigna–HealthSpring customers benefit from nearly 280 engaged physician relationships across 31 states, with more than 79,000 doctors participating, including more than 33,000 primary care physicians and more than 46,000 specialists.