CIGNA/Eastern Maine Health Systems

Region Within State: 
Northern Maine
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Friday, January 1, 2010
Pilot/Demo Length: 
undetermined

CIGNA's Collaborative Medical Home initiative with EMHS is designed to use patient level actionable data and performance data to support practice actions with the goals of improving quality of care, affordability of care and patient satisfaction.  The project currently involves 7 practices and 75 primary care physicians located in the greater Bangor area.  Practices have expanded office hours and hired embedded care coordinators to better engage patients

Type of Practices: 
Other
CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
CIGNA HealthCare
Primary Contact: 
Mark Still
E-mail: 
[email protected]
Additional Contact
Name: 
Harriet Wallsh
Mark Slitt- media Contacts
Participating Stakeholders: 

CIGNA Healthcare, Estern Maine Health Systems employed physician practices

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
7
Number of Participating Physicians: 
30
Physicians per practice: 
varies
Types of Practices: 
InternalMedicine, Family Practice, Pediatrics
Health Plan Lines of Business Included: 
HMO, POS, PPO & Open Access
Overall Number of Covered Lives: 
4000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: 100%
Estimated % of practices with electronic medical record: 100%
Estimated % of practices with registry software: 100%
Other

Consumer Involvement: 

Several of the practices have patient advisory groups to provide the practices with feedback and advice.

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

·          Reduce inappropriate use of ER

·          Reduce readmissions

·          Improve generic prescribing

·          Better patient engagement with and use of primary care practice

 

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

EMHS is charged with implementing the PCMH model throughout its integrated health system, resulting in level III NCQA recognition for several of its practices; other practices are expected to follow suit and efforts are under way to expand the project from the initial 7 practices to all 31 EMHS employed practices. The EMHS practices involved in the project have a robust electronic medical record system and have instituted a disease registry system.  Embedded care coordinators were hired and are centrally located 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/outreach, family inclusion, greater knowledge of CIGNA and community resources and their use as needed. E-prescribing—EMHS is implementing e-prescribing at its PCMH practice sites.  EMHS EMR has also enabled the practices to institute an eVist process for patients

Payment Model: 

There is a small up front enhanced care coordination fee to support the care coordination activities with the opportunity for the practice to increase the care coordination fee by demonstrating better than market quality and cost effectiveness outcomes.

PROJECT EVALUATION
Types of data to be collected : 

CIGNA’s assessment process looks at quality, through evidence based measures and total medical cost improvements to drive a financial reward to the practice for superior quality outcomes and efficiency performance.