- Value-based episodes-of-care model uses incentives to engage health care providers
- Helps drive improved health, affordability and experience
- Cigna’s first chronic episodes-of-care arrangement for cardiology
MIAMI- Cigna (NYSE: CI) and HeartWell LLP (HeartWell) 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 health care 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 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
- Reduced frequency of post-surgery complications, including deep vein thrombosis (blood clots in deep veins), pulmonary embolisms (blockage of arteries in the lungs), wound infections and strokes.
“We’ve had solid results from our ongoing Cigna Collaborative Care arrangements with primary care physician groups and we’re also having success as we extend our value-based arrangements into specialty care. We look forward to collaborating with HeartWell as we take this important next step into value-based cardiac care,” said Marco Vitiello, M.D., Cigna’s medical executive for South Florida.
“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.
“Chronic conditions – such as diabetes and heart disease – can have a significant impact on an individual’s overall health and quality of life. Our hope is that initiatives like this will help improve lives and contain health care costs by reducing the need for emergency room visits and hospitalizations,” said Dr. Vitiello.
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.
HeartWell, LLP is a medical practice consisting of 23 cardiologists in nine offices in South Florida, with a concentration in the Kendall/Coral Gables area. Every patient of a HeartWell physician receives an accurate, thorough evaluation and diagnosis, followed up by the most advanced solutions available to appropriately manage cardiovascular diseases through the timely application of lifestyle changes, medical therapies, and interventional technologies.
HeartWell’s physicians are among the most skilled and respected doctors in the area who all provide personalized care—including education about preventive measures—for patients who have, or are at risk for, cardiac and vascular diseases.
Among the many services and specialties are office based services such as arrhythmia management, cardiovascular research, coronary disease management; diagnostics such as carotid ultrasound studies, echocardiography, smoking cessation strategies; and hospital/outpatient services including cardiac catheterization, interventional cardiology and implantation of pacemakers and defibrillators. For more information, visit www.heartwell.com.
Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has more than 90 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.