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Two Health Provider Organizations in Texas Join Cigna’s ‘Collaborative Care Program’

July 9, 2014
by John DeGaspari
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Care coordinators use patient specific data supplied by the insurer to enhance care

Two Texas provider organizations have joined Cigna’s Collaborative Care program, which the insurer says is aimed at improving patient access and enhancing care coordination, according to the insurer. The programs both became effective July 1, with a total of 11 Cigna collaborative care arrangements in Texas.

The two providers are Austin Diagnostic Clinic, located in Austin (3,500 individuals covered by a Cigna health plan who are cared for by 120 primary care doctors and specialists), and St. Joseph Health System in Bryan, Texas (3,500 individuals covered by a Cigna health plan who are cared for by 120 primary care doctors and specialists).

Under the program, the provider organizations monitor and coordinate all aspects of the individuals’ medical care. Registered nurse clinical coordinators employed by the provider organizations help patients with chronic conditions and other health issues navigate the health system; the care coordinators are also aligned with Cigna case managers for better collaboration between the provider and the payer, according to Cigna.

The care coordinators use patient-specific data to help identify patients being discharged who might be at risk of readmission, as well as patients who may be overdue for health screenings or who may have skipped a prescription refill. The care coordinators are part of a physician-led care team that can help get follow-up dare or screenings, identify potential problems related to medications, and help keep chronic conditions in check, according to the insurer. Care coordinators also help schedule appointments, provide health education, or refer patients to Cigna’s clinical support programs.

Cigna will compensate the provider organizations for the medical and care coordination services that doctors provide, and the provider organizations may also be rewarded through the insurer’s “pay for value” structure for meeting quality and cost targets.

 

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