CIGNA and Dartmouth-Hitchcock Patient-Centered Medical Home Pilot

Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Sunday, June 1, 2008
Pilot/Demo Length: 
2-3 years

CIGNA and Dartmouth-Hitchcock (D-H) launched a PCMH pilot program June 1, 2008 with the goal of improving the quality, affordability and patient satisfaction with care through collaboration and aligned incentives. The program has three key components: clinical information, clinical collaboration, and a blended payment model.

Along with a member roster, CIGNA provides D-H with lists of identified high risk patients according to mutually agreed upon criteria. D-H provides “embedded case management services,” i.e., a nurse who helps to coordinate the care of the patient with the goal of improving quality and reducing avoidable ER visits and hospitalizations for this high risk group and others identified. CIGNA also provides D-H with electronic feeds of “gaps in care” where identified issues such as medication compliance or needed preventive health care can be addressed at the time of the patient’s next visit. Clinical collaboration between CIGNA and D-H encourages patient access to key programs.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
CIGNA HealthCare
Primary Contact: 
Harriet Wallsh, RN
E-mail: 
[email protected]
Phone: 
407/691-0103
Participating Stakeholders: 

CIGNA HealthCare; Dartmouth-Hitchcock Clinic.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
5
Number of Participating Physicians: 
253
Physicians per practice: 
25
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics
Health Plan Lines of Business Included: 
Commercial
Overall Number of Covered Lives: 
16600
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: >95%
Estimated % of practices with registry software: >95%
Other: Patients may schedule appointments on line, have e-visits, health record access, and self management tools through the D-H library

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination
Increased Access Information Technology (e.g., registries, patient portals)
New pay for performance models
Team Approach to Care

Services participating practices have added as a result of their participation: 

1. D-H’s Regional Primary Care Center is charged with implementing the PCMH concept at D-H, resulting in NCQA recognition for several of its practices; other practices are expected to follow suit. The Center will facilitate the evolution of primary care through a comprehensive PCMH in partnerships with patients, families, the community, and the greater health care system. 2. The Regional Primary Care Center supports various committees to vet and implement operational strategies in support of the medical home concept, such as evidence based care guidelines, patient communications, access to services, optimizing workflows. 3. Embedded care coordinators were added to each practice location to support patient care and care plan development; act as patient navigators; ensure patient transitions (i.e. post-hospital discharge, MD-MD) are smooth and completed; and support patient education, family inclusion, greater knowledge of CIGNA and community resources and their use as needed. Written resources including instructions for self care/day care plans and when/who to call for support are shared with patients. 4. Patient data coordinators have been added to each practice to work with the disease management registries for each physician, to identify service or test needs based on evidence based care guidelines, and either order the service based on standard ordering guidelines or communicate the need to the patient care team. 5. Process improvement and workflow reengineering has been implemented for all D-H practice locations to support the medical home concept. 6. E-prescribing—D-H has implemented ePrescribing in the Concord & Keene locations but it is not currently in sites with the D-H CIS home-grown electronic health records. The CIS sites will change over to EPIC and then have ePrescribing capabilities with a target of transition in 2011.

Payment Model: 

Enhanced fee schedule plus reward for outcomes based on improvements in quality and affordability of care.

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Are the practices involved in the

Which of the data types are being shared?: 

Clinical data share

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes, Health insurance providers involved in the demonstration