CIGNA and Piedmont Physicians Group Launch Accountable Care Organization Pilot Program

CIGNA and Piedmont Physicians Group, part of Piedmont Healthcare, have launched an accountable care organization (ACO) pilot program. With a comprehensive, accountable and collaborative approach to medical care, the ACO pilot is expected to improve access to and quality of patient care, and provide better care coordination while lowering medical costs.

An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. CIGNA’s program with Piedmont is one of the first patient-centered pilot programs in the Atlanta area involving a medical practice and a single private payer and is the first accountable care organization in Georgia.

The program, which began July 1, is focused on approximately 10,000 individuals covered by a CIGNA health plan who receive care from one of Piedmont’s more than 100 primary care physicians who are members of the Piedmont Physicians Group.

During the ACO pilot, a Piedmont Physicians Group practice will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current Piedmont physician and will not need to do anything to receive the benefits of the ACO pilot. There also is no change in any plan requirements regarding referrals to specialists.

Key to the CIGNA/Piedmont program is a registered nurse, funded by CIGNA and employed by Piedmont, who serves as a clinical care coordinator to help patients with chronic conditions or other health challenges navigate their health care system. The care coordinator will enhance patient care by coordinating CIGNA data and clinical programs of the Piedmont Physicians Group, as well as communications, appointment availability and education around those clinical programs. Using CIGNA data to help drive improved outcomes is one of the core strengths of the program.

“We believe that we can achieve better clinical outcomes by adopting a patient-centered model of primary care,” said Dr. David Epstein, CIGNA’s senior medical director for Georgia. “Health care in the United States has shifted away from prevention and primary care, which has resulted in a ‘disease care’ system that relies more on specialist intervention and rescue procedures rather than improving health and providing greater value to patients. The patient-centered model places the focus back where it belongs – on improving the health of individuals through comprehensive primary care services and delivering better outcomes through enhanced care coordination.”

CIGNA will pay the primary care physicians of the Piedmont Physicians Group as usual for the medical services they provide, plus an additional fee for care coordination and other medical home services. The physicians also will be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs. According to CIGNA’s Epstein, emphasizing the value of the primary care physician will help increase the professional satisfaction and financial rewards for doctors who practice in primary care.

CIGNA will evaluate results after the program has been operational for at least 12 months. The pilot is one of many that CIGNA participates in nationally and is intended to help the company gather data about the effectiveness of the patient-centered model.