CIGNA and ProHealth Physicians Create Enhanced Care Coordination Program

BLOOMFIELD & FARMINGTON, Conn.- CIGNA (NYSE:CI) and ProHealth Physicians, Inc., have expanded their longstanding relationship by implementing an enhanced care coordination program that includes pay-for-performance provisions and many of the features of a patient-centered medical home program. This is the first program of its kind in Connecticut.

In a medical home model of primary care, a team of health professionals works together to provide enhanced patient care, including care coordination. This team may include a doctor, nurses, a health educator and other professionals who can provide individualized care and health coaching. One of the goals of a medical home is to increase patient access to care, so ProHealth will help patients obtain services that are appropriate to that individual’s age and situation, particularly patients with chronic conditions, such as heart disease or diabetes.

CIGNA and ProHealth will each designate a care coordinator who will manage enrollment in and encourage use of disease management programs, consult on issues related to evidence-based medical guidelines, help improve adherence to overall care plans, analyze CIGNA’s Well Informed report that identifies opportunities for potential care improvement, and coordinate communication with health plan participants. ProHealth will earn higher reimbursements if it meets certain quality and efficiency targets.

“CIGNA and ProHealth share common goals: to improve the quality and affordability of health care and increase patient satisfaction among the people we jointly serve,” said Dr. Dick Salmon, a primary care physician and national medical director for CIGNA. “This new arrangement emphasizes the value of the primary care physician as the overall coordinator of their patients’ health, and it will help increase the professional satisfaction and financial rewards for primary care physicians while achieving better outcomes for patients.”

“ProHealth remains committed to transforming the delivery of care and we are very pleased to be working with CIGNA to exemplify the improvements that can be attained through our collaboration,” said Dr. Jim Cox-Chapman, chief medical officer of ProHealth. “This relationship will enable each of our organizations to contribute our unique strengths toward improving clinical outcomes, providing more comprehensive coordination of care, and applying the fundamental principles of the medical home model to increase access and reduce unnecessary duplication of services. Through the use of technology and enhanced data tools, the health care professionals in our practice will be enabled to make informed decisions, develop care plans, and offer educational materials that allow patients to better engage in self-care that extends beyond the office visit.”

ProHealth will develop and adopt care guides for five chronic conditions - diabetes, ischemic heart disease, congestive heart failure, asthma and a fifth chronic condition that will be identified later. The arrangement also calls for ProHealth to use electronic health records and e-prescribing for greater efficiency and to increase patient access through extended daily hours, telephonic consulting on weekends and by providing weekend acute care.

The care coordination program will focus on three categories of high risk participants initially: people at high risk for hospital readmission, those at high risk for health deterioration, and individuals identified through CIGNA’s Well Informed reporting.

ProHealth serves approximately 20,000 people in Connecticut who are enrolled in a CIGNA health plan and has 74 locations throughout the state.