Value-based episodes-of-care model uses incentives to engage health
- Helps drive improved health, affordability and experience
- Cigna’s first chronic episodes-of-care arrangement for cardiology
MIAMI–(BUSINESS WIRE)–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
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
“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,
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.