Cigna and Partners In Care Launch First Accountable Care Program in New Jersey Involving an Independent Physicians Organization and a Health Plan

BLOOMFIELD, Conn. & NEW BRUNSWICK, N.J., December 20, 2011 – Cigna (NYSE:CI) and Partners In Care (“PIC”), an independent physicians organization based in Central New Jersey, have launched a collaborative accountable care initiative to expand patient access to health care, improve care coordination, and achieve the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction. Collaborative accountable care is Cigna’s approach to accountable care organizations, or ACOs.

An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. Cigna’s program with PIC is the first patient-centered accountable care program in Central and Northern New Jersey involving an independent physicians organization and a health plan.

The program is focused on approximately 14,000 individuals covered by a Cigna health plan who receive care from among 360 doctors at more than 160 participating physician practices. Individuals who are enrolled in a Cigna health plan and later choose to seek care from one of the participating practices will also have access to the benefits of the program.

“Patients with chronic conditions, such as diabetes or hypertension, see many different specialists and health care professionals with little to no coordination among them. It is unnecessary, disorganized and dangerous,” said Steven Goldberg, M.D., chairman, PIC. “Monitoring these patients and ensuring their care givers are talking to one another – with one patient-selected personal physician in the leadership role – will undoubtedly lead to safer, more consistent, and more effective medical care.”

“Cigna and Partners In Care have shared values, and the commitment to patient-centered care is evident in every aspect of this program,” said Kevin O’Brien, president & CEO, PIC. “As we work together to help patients remain healthy, the overall costs are less – it’s a win for everyone.”

The participating physician practices will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physician and will not need to do anything to receive the benefits of the program. There also 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 clinicians and registered nurses, employed by Partners In Care, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators will enhance care by using patient-specific data that Cigna provides to 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 will work with the patient’s physician to help patients get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators will also help an individual’s medical home provide health education and refer individuals to Cigna’s clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.

“The current health care system is focused on treating illness and rewards physicians for volume rather than value; it’s not designed to drive long-term health improvement and lower costs,” said Dr. Ron Menzin, Cigna’s medical director for New Jersey. “If our goal is a healthier population and lower medical costs, we need to create a patient-centered health care system that emphasizes prevention and primary care and that rewards physicians for quality of care and improved health outcomes.”

Cigna will pay physicians as usual for the medical services they provide. Partners In Care will also pay the physicians for the care coordination services they provide on the patient’s behalf. Additionally, physicians may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.

“Employers bear a large portion of the nation’s health care costs, so it’s important to them to find a model of health care that can lower these costs through improved employee health,” said Laurel Pickering, president & CEO of the Northeast Business Group on Health (NEBGH). “This patient-centered collaboration between Cigna and Partners In Care is an excellent example of how health plans and physicians can work together to achieve a healthy, productive work force and create a health care system that works for everyone.”

The principles of the patient-centered medical home are the foundation of Cigna’s collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with the physician practice. With the addition of Partners In Care, Cigna is now engaged in 17 patient-centered initiatives in 15 states, encompassing more than 170,000 Cigna customers and more than 1,800 primary care physicians, including multi-payer pilots and Cigna-only collaborative accountable care initiatives. The company plans to continue increasing the number of initiatives significantly in 2012. Cigna has been a member of the Patient-Centered Primary Care Collaborative since October 2007.

About Cigna

Cigna (NYSE: CI) is a global health service and financial company dedicated to helping people improve their health, well-being and sense of security. Cigna Corporation’s operating subsidiaries in the United States provide an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance.

About Partners In Care

Partners In Care, Corp. (PIC) is a privately held, physician owned, for-profit provider of healthcare and management services. With a broad network of independent community physicians throughout New Jersey.

IncentOne Launches Outcomes-Based Biometrics Incentive Solution

Lyndhurst, NJ (PRWEB) December 08, 2011, IncentOne, a provider of incentive solutions to the healthcare industry, has launched what it says is the first outcomes-based biometric incentive program through its Health Power™ platform. With this solution, IncentOne will enable payers, health service companies, employers, governments and administrators to align incentives to outcomes and improvements in 20 different biometric measures.

Key features of the solution include the ability to:

  • Combine outcomes and participation-based programs
  • Set desired biometric outcomes for 20 measures including Body Mass Index, Blood Pressure, Waist Circumference, Waist to Hip Ratio, Total Cholesterol, HDL Cholesterol, HDLc Ratio, Triglycerides, Glucose, A1C, Cotinine, and LDL Cholesterol
  • Set absolute, percentage or minimum improvements for each measure
  • Incentivize for single or multiple biometric measures attained
  • Set different target levels for men and women for each measure
  • Implement pass/fail criteria for each measure
  • Integrate data from past testing periods
  • Utilize multiple testing periods
  • Utilize physician attestation forms for alternative facilities
  • Allow for reasonable alternative health activities based on physician recommendations
  • Manage the process for contested measures

“Biometrics are a central component of any outcomes-based engagement strategy.” says Michael Dermer, President and CEO of IncentOne. “Our customers can now execute a wide variety of outcomes-based designs tied to biometric data that have demonstrated cost savings. We believe that Incentive Driven Healthcare™ is the next wave in healthcare and this is one step to help our customers see that movement in action.”

About IncentOne
IncentOne delivers cost savings and health improvement by engaging healthcare consumers and providers through the use of incentives. IncentOne serves customers representing more than 75 million lives, has processed 20 million health transactions and driven 15 million health milestones through 125 data partners. IncentOne’s Universal Remote™ technology enables customers to drive “any action for any value for any reward via any medium” and to align incentives not only to long-term savings but also to immediate and intermediate savings via its Trifecta™ methodology. IncentOne’s solutions are married with leading-edge strategies such as value-based benefit design, medical homes, accountable care organizations, telehealth, pay-for-performance and provider payment reform to deliver true engagement. IncentOne programs target consumers to improve utilization, increase prevention, avoid hospitalizations, reduce readmissions, choose lower cost providers, reduce health risks, increase medication adherence and steer benefit selection and providers to adopt e-prescribing and EMR technology, adhere to treatment protocols, and improve patient safety. For more information go tohttp://www.incentone.com.

 

Competing to Win: TriZetto Suggests Healthcare Payer Strategies for Growth in Emerging Retail Market

DENVER–(BUSINESS WIRE)–According to The TriZetto Group, as payers continue to make the necessary business changes to comply with reform, increase administrative efficiency, and improve the cost and quality of care, these organizations will face an additional challenge—competing to win in an emerging retail market.

“Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits”

To compete effectively, it is imperative that payers stand out from the crowd and differentiate themselves with new products that drive value, increase transparency, and create opportunities for collaboration with providers and other healthcare stakeholders.

Markets for Expansion and Growth

A winning strategy involves optimizing enterprise platforms, including core administration, network management and care managementsystems, through integration. The integration of these systems can help strengthen key lines of business that are poised for rapid growth in the wake of health reform. TriZetto has identified four major markets where expansion opens new opportunities for payers:

  • Individual market
  • Ancillary services
  • Medicaid managed care
  • Medicare managed care

Prepare for Newly Insured Individuals

Beginning in 2014, 24 million people are expected to enroll in health plans via exchanges.i Payers that invest in scalable, flexible enterprise systems that can be configured to respond to changing needs will have the agility to participate in a wide variety of new opportunities related to the burgeoning exchange market.

With integrated systems, payers can use clinical analytic tools to harness the rich data in their applications to strategically address the individual market, segment populations and proactively help high-risk members manage their own health effectively. System integration also helps optimize the enrollment, eligibility, renewal and billing/collection processes.

Diversify by Growing Ancillary Services

Health plans can differentiate their brands by growing ancillary services and extending these offerings to individuals who enter exchanges and to those who have only medical coverage. Research published in 2009 by the U.S. Bureau of Labor Statistics indicated that 71 percent of workers in private industry had access to medical care benefits, 46 percent had access to dental care benefits and 27 percent had access to vision care benefits.ii A major goal of growing ancillary services such as vision and dental is to capitalize on high-growth margins by providing coverage for services typically excluded or only partially reimbursed by health plans today.

To respond quickly to these new opportunities, payers need an enterprise-wide core administration system that maximizes efficiencies through greater automation and enables seamless transactions among providers, members and payers. In addition, integrated network management systems can help payers efficiently and accurately pay claims across multiple services and providers.

Prepare for Medicaid’s Shift to Managed Care

According to the Kaiser Family Foundation, about 70 percent of new Medicaid enrollees will enter managed care organizations.iii This shift from traditional fee-for-service Medicaid coverage creates opportunities for payers to enhance services that help manage care and control costs for a vulnerable population, as well as increase the number of those served under new and existing Medicaid managed care plans.

There are two key areas where IT investments may help drive payer success in the Medicaid market. First, healthcare analytics can help payers and providers identify high-risk populations and proactively manage care for these members. Analytics also can help payers model and compare the value and costs of clinical and incentive-based programs.

Second, technology for value-based insurance design, which incents members to manage their own care more effectively, also supports payer goals in the Medicaid market. By proactively engaging members with personalized wellness, support and educational programs through web portals, e-mail and other automated communications, payers can help improve member health and control costs.

Invest in the Growing Senior Market

With more than 10,000 people a day (i.e., approximately 3.5 million annually) becoming eligible for Medicare, the senior market cannot be ignored.iv Despite less favorable reimbursement rules, the shift from traditional Medicare fee-for-service to managed care continues to create opportunities for payers and providers to work collaboratively toward improving the cost and quality of care for seniors. These opportunities include:

  • Developing innovative payment structures such as pre-approved bundling of all provider services for an agreed-upon amount
  • Creating methodologies for sharing risk in collaborative care settings
  • Aligning incentives based on provider adherence to clinical protocols
  • Profiling segments of members to find new ways to attract seniors who expect retail-type
  • services and personalized care
  • Managing seniors collectively who have both commercial and Medicare coverage

The emerging retail market presents compelling opportunities for profitable growth. Watch for healthcare payer organizations to leverage technology-enabled business solutions to compete and win in this new, evolving market.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component softwaremanaged application services, managed business services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.

Footnotes

i. Pear, Robert, “Heath Care Overhaul Depends on States’ Insurance Exchanges,” The New York Times, Oct. 23, 2010
ii. U.S. Bureau of Labor Statistics, “Spotlight on Statistics,” November 2009. http://www.bls.gov/spotlight/2009/health_care/
iii. Kaiser Family Foundation, “Medicaid and Managed Care: Key Data, Trends, and Issues,” The Kaiser Commission on Medicaid and the Uninsured. February 2010. http://www.kff.org/medicaid/upload/8046.pdf
iv. PolitiFact.com, “Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits,” Richmond Times Dispatch, May 4, 2011.http://www.politifact.com/virginia/statements/2011/may/04/eric-cantor/rep-eric-cantor-says-10000-baby-boomers-day-are-be/

 

Contacts

 

HealthRally Raises $400K to Motivate Wellness

SAN FRANCISCO–(BUSINESS WIRE)–HealthRally, a social health company developing a new crowdfunding platform for personal health motivation, announced that it raised more than $400,000 in seed funding and assembled an expert board of strategic advisors.

The company is building a social health platform focused on inspiring the nearly 100 million Americans who spend over $50 billion annually trying to achieve wellness goals such as losing weight, quitting smoking, or improving one’s overall health and fitness.

The seed round was funded by Esther Dyson, a prominent angel investor in disruptive technologies; Isy Goldwasser, a successful biotech entrepreneur; Dick Sass, a medical device entrepreneur; Ty Danco, a prolific angel investor; and Jeff Thiel, a former Microsoft executive.

“Games and badges are great, but most people would probably rather have an iPad, a vacation, or cool new pair of shoes,” says Zack Lynch, CEO and co-founder of HealthRally. “HealthRally combines the power of social networks with the latest findings in behavioral science for healthy motivation and sustained support.”

HealthRally ties together advances in behavioral economics — which shows that financial incentives triple one’s chance of reaching a health goal — with cutting edge social networking science — which proves that engaging close friends and family increases success rates. In practice, when friends and family contribute financially to one’s goals, peer support and success rates dramatically increase.

“It’s the oldest trick in the book,” says Esther Dyson. “Make a commitment to a group of friends, and you ‘have’ to deliver! HealthRally helps you assemble the friends and manage the process, and adds the psychological value of making the commitment and incentives explicit and formal.”

HealthRally’s advisory panel includes researchers and entrepreneurs with deep experience in behavioral economics and social networking, including: Paul Zak, Director, Center for Neuroeconomic Studies, Claremont Graduate University; Tom Valente, Social Networks and Health expert, Keck School of Medicine, USC; Denise Thomas, former President, Healthiest You; and Ross Mayfield, Chairman and co-founder, Socialtext; among others.

The company is currently in private beta and will be launching a public beta in time to help people conquer their New Year’s resolutions. Individuals can request an invitation to participate at www.healthrally.com.

About HealthRally

HealthRally is a social health company that has developed a crowdfunding platform that uses social motivation and positive financial incentives to inspire people to achieve their health and wellness goals. HealthRally was co-founded by Zack Lynch and Peter Kaminski. Zack is the founder of the Neurotechnology Industry Organization and author of The Neuro Revolution: How Brain Science Is Changing Our World (St. Martin’s Press.) Peter has been technical co-founder at several companies including Socialtext and Yipes Communications.

 

Contacts

HealthRally
Zack Lynch, 415-279-7462
CEO
Zack.lynch@healthrally.com
or
Ross Gillfillan, 415-599-4403
ross@torchcommunications.com