January 31, 2017 — Cigna and HeartWell LLP have launched a program to improve quality and cost of care for people diagnosed with chronic coronary artery disease.
The program is part of Cigna Collaborative Care, a value-based model that uses incentives to engage healthcare providers and helps drive improved health, affordability and patient experience. Cigna Collaborative Care initially focused on large primary care physician groups and later expanded to include hospitals, small primary care practices and specialists, such as orthopedists, oncologists and cardiologists.
Under the new initiative, HeartWell, a South Florida-based health system, will continue to be paid for the medical services it provides to its Cigna patients. It will also be eligible to earn shared savings if it meets certain quality targets and if the actual cost for an entire episode of care is below a risk-adjusted expected cost. An episode of care includes pre-care, cardiovascular procedures (such as cardiac catheterizations and coronary angioplasty), medications, recovery and follow-up care through 12 months following the procedure.
After the episode of care has ended, Cigna will evaluate all of the claims for that episode, adjust for risk and determine if the total actual cost is below the expected cost. If it is, HeartWell will receive a portion of those savings — but only if it also meets specific quality targets.
The quality targets include:
- Reduced number of hospital readmissions; and
- Reduced frequency of post-surgery complications, including deep vein thrombosis, pulmonary embolisms, wound infections and strokes.
“At HeartWell, we believe in working closely with patients and their primary care physician to keep them healthy. We strive to help our patients live better lives through the high-quality care we provide,” said Jonathan Fialkow, M.D., managing member. “We are pleased to be the first cardiology group in the nation to partner with Cigna on this type of arrangement focused on the value of care rather than volume of care. We look forward to working collaboratively on this initiative to improve the quality and affordability of care.”
This is Cigna's first chronic episodes-of-care arrangement for cardiology.
Cigna has episodes-of-care arrangements for other medical specialties, including orthopedics, oncology, gastroenterology and obstetrics/gynecology. It also has pay-for-performance arrangements for obstetrics/gynecology and oncology.
For more information: www.heartwell.com, www.cigna.com