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Valley Preferred and Cigna Connect for Accountable Care

June 26, 2013
by Rajiv Leventhal
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Cigna and Valley Preferred, a provider-owned, preferred provider organization aligned with Lehigh Valley Health Network in Allentown, Pa., are launching a collaborative accountable care initiative to improve patient access to healthcare, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience.

The program, Cigna's first collaborative accountable care initiative to launch in Pennsylvania, is effective July 1. The program will benefit approximately 5,500 individuals covered by a Cigna health plan who receive care from Valley Preferred primary care and specialty physicians.

Under the program, Valley Preferred physicians monitor and coordinate all aspects of an individual’s medical care. Patients continue to go to 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 Valley Preferred physician will also 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 or heart disease.

Critical to the program’s benefits are Valley Preferred registered nurses who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the healthcare system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the physician practice and Cigna that ultimately results in a better experience for the individual, said Cigna officials.

The care coordinators 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 helps patients get the follow-up care or screenings they need, identifies potential complications related to medications and helps prevent chronic conditions from worsening.

Care coordinators can also help patients schedule appointments, provide health education and refer patients to Cigna's clinical support programs that may be available as part of their employee benefits plan. Examples include disease management programs for diabetes, heart disease and other conditions, and lifestyle management programs for tobacco cessation, weight management and stress management.

Cigna will compensate Valley Preferred physicians for the medical and care coordination services they provide. Additionally, they may be rewarded through a “pay for value” structure for meeting targets for improving quality and lowering medical costs.

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