Insurance Carriers Reducing the Cost of Care

This week I am attending the Cigna National Producer Advisory meeting. I am pleased to say that Cigna, as well as all the national insurance carriers, are busy moving forward the goal of reducing healthcare costs by aligning interests. Physicians will receive additional compensation if results establish quality care, a favorable member experience and affordability of the care they provide. This payment system replaces the failed fee-for-service model that is based purely on the amount of care rendered.  

Cigna has a short-term target of converting of 50% of medical payments to alternative (risk-based) payment models and 90% to value- (outcomes-) based models. Risk-based payment arrangements are key to the success of value-based care. As of the second quarter of 2017, 43% of Cigna’s care is reimbursed through a collaborative provider arrangement and 57% of payments are aligned to outcomes.

They are targeting their contracting to hospital and specialty groups, as well as ancillary providers, and are providing actionable analytics along with an embedded care coordinator (or care manager) who personalizes the care process. Care coordinators are hired by the provider group, but funded through the payment model. They have access to electronic medical records and can flag medical concerns using the full spectrum of the patient’s medical treatment; not just those of that provider. 

Cigna believes that risk-based contracting can shave a meaningful 8–12% decrement off the non-incentive model. This sounds like a good start. Everyone in the healthcare value chain has to do their part to mitigate costs.

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