In a statement outlining the initiative, the insurance giant said it believes the partnership with GHN is the largest accountable care program in New Hampshire to link doctors, hospitals, and a single health plan.
The Granite Healthcare Network comprises five healthcare delivery organizations: Concord Hospital, Elliot Health System, LRGHealthcare, Southern New Hampshire Health System, and Wentworth-Douglass Hospital. Each organization is an independent, integrated healthcare delivery system consisting of primary care doctors, specialists, and hospitals. All GHN hospitals have electronic health records (EHRs) and other advanced health IT tools.
According to Cigna officials, the program will benefit more than 23,000 individuals covered by a Cigna health plan who receive care from among more than 900 GHN-participating healthcare professionals. Individuals who enrolled in a Cigna health plan and who later choose to seek care from a GHN-participating physician will also have access to the program's benefits.
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In an interview, Donald Curry, president for Cigna in New England, explained that Cigna runs claims data through Episode Treatment Group and evidence-based medicine software to identify ways to improve quality of care and lower costs. Like other health insurers that are implementing business intelligence tools, Cigna will apply analytics software to monitor GHN patients.
Curry said the data collected creates patient-specific reports that help care coordinators spot at-risk patients, reports that the system will transfer to care coordinators through a secure connection. The ACO will also use this information to generate performance reports that help physicians improve their care.
"On a daily basis, we will provide GHN with information about GHN patients who have received care in non-GHN hospitals--for example, people who are traveling," Curry told InformationWeek Healthcare. "On a monthly basis, we will leverage our claims data to provide information about which patients have potential 'gaps in care' (missed prescription refills, etc.) and which patients are at highest risk for health deterioration based on our predictive models." The analytics gathered on patients, especially those with chronic illnesses, will help care coordinators identify events such as missed medications or scheduled appointments. Care coordinators can contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications, and help prevent chronic conditions from worsening.
These coordinators will also help patients schedule appointments, provide health education, and refer patients to Cigna's clinical programs. Among those resources are 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.
As the ACO increasingly uses business intelligence tools, EHRs, and other health IT tools, Curry said health providers can expect greater efficiency and access to more critical patient data. "Technology will enable more efficient communication between the health plan and the clinical organizations, and put useful information in the hands of the healthcare professionals who are coordinating the care and outreaching to the patients most in need," Curry observed.
In a statement, Paul Grundy, global director of healthcare transformation at IBM and president of the Patient-Centered Primary Care Collaborative, described the initiative as an example of how health plans can work with physicians and hospitals to create a better healthcare system.
"Putting patients and their families at the center of care gives patients much better access to care, empowers them to communicate more effectively with their healthcare professional, gives physicians tools to better integrate and coordinate care, and helps improve the healing relationship between patients and their doctors," Grundy said.
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