Data Published in Health Affairs Demonstrates Improved Health Outcomes and Lower Costs Associated with Cigna's Collaborative

  Data Published in Health Affairs Demonstrates Improved Health Outcomes and
  Lower Costs Associated with Cigna's Collaborative Accountable Care Program

  *Health Affairs publishes first peer-reviewed study highlighting interim
    results from Cigna’s collaborative accountable care initiative
  *Cigna’s collaborative accountable care model shows positive trends in
    quality of care and total medical cost management
  *Registered nurse care coordinators are central to success of the program
  *Physician practices rewarded for improving patient outcomes and lowering

Business Wire

BLOOMFIELD, Conn. -- November 12, 2012

A study published in the November issue of the leading policy journal Health
Affairs shows that Cigna's (NYSE: CI) collaborative accountable care (CAC)
model has favorable quality of care and total medical cost trends. The study
reports interim quality and cost results among three geographically and
structurally diverse physician practices in Arizona, New Hampshire and Texas.
Results suggest that a shared savings accountable care model with
collaborative support from the payer can enable physician practices to take
meaningful steps toward full accountability for care quality and efficiency.

Cigna's CAC model, based on principles aligned with accountable care
organizations (ACOs), is focused on the “triple aim” of improving health
outcomes, reducing medical costs and increasing patient satisfaction.
Participating physician groups focus on closely monitoring individuals who are
at high risk for adverse health events, including patients with chronic
conditions such as diabetes or cardiovascular disease.

The study in Health Affairs reports on 2010 results for quality of care and
total medical costs at Dartmouth-Hitchcock in New Hampshire, Medical Clinic of
North Texas (MCNT), and Cigna Medical Group of Arizona (CMG).

The study showed that CMG’s total medical costs for 2010 were significantly
reduced ($27.04 per patient per month) compared with other practices in the
same geographic area (p < 0.10). Compared with expected costs,
Dartmouth-Hitchcock and MCNT achieved performance improvements in their per
patient, per month costs ($1.78 and $6.56 respectively), although CMG showed a
decrease of $4.94. The study also showed that the three practices
out-performed their comparison group peers on all care quality measures, with
one exception.

Aggregate risk-adjusted medical costs per patient per month were calculated to
evaluate the effect of the initiative on total medical expenditures.
Performance improvement was based on the difference between a practice’s
risk-adjusted expected costs for 2010 and its actual costs in the same year.
The study assessed care quality by comparing compliance rates between
practices in the initiative and their comparison groups for each patient on 69
evidence-based measures of care.

“The study data confirmed our expectations that physician practices and
patients can benefit from accountable care-based models, and underscore
previous reports suggesting that Cigna’s collaborative accountable care
initiative is a viable system to improve quality, drive cost savings and
increase patient satisfaction,” said Dick Salmon, M.D., Ph.D., Cigna’s
national medical executive for performance measurement and improvement. “In
addition, we saw that participating medical practices increased their success
by using registered nurses as care coordinators to oversee the implementation
of the CAC program at the facility. In a diverse group of practices where CAC
programs have been implemented, we’ve noticed a positive trend in overall care
improvement, particularly with respect to closing gaps in patient care through
collaboration and communication.”

The CAC initiative, which Cigna launched in 2008, is a shared savings program
that offers practices up-front support in their first year of participation
and performance incentives for subsequent years. The initial financial support
comes in the form of a care coordination payment for investments in
infrastructure that will improve patient care while keeping total medical
costs down. In subsequent years, practices receive a larger care coordination
payment if they meet targets for improved outcomes and lower medical costs.

Critical to the programs’ benefits are registered nurses, employed by the
physician practices, who serve as clinical care coordinators and help patients
with chronic conditions or other health challenges navigate the health care
system. Care coordinators from each physician practice are aligned to a team
of Cigna case managers to ensure a high degree of collaboration between the
medical group and Cigna that ultimately results in a better experience for the

The care coordinators enhance care by using patient-specific data provided by
Cigna to identify patients being discharged from the hospital who might be at
risk for readmission, as well as patients who may be overdue for important
health screenings or who may have skipped a prescription refill. Care
coordinators 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.

Care coordinators also help patients schedule appointments, provide health
education and refer patients to Cigna's clinical programs, such as 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.

Cigna also provides CAC physician practices with performance reports that
suggest opportunities for improving care quality and controlling costs. For
example, the report might show that the practice’s patients are heavy users of
hospital emergency rooms. This might suggest the need for the practice to
offer extended evening or weekend hours to improve patient access to care.

Cigna is now engaged in 42 collaborative accountable care initiatives in 18
states, encompassing more than 390,000 Cigna customers and more than 5,500
primary care physicians. Cigna plans to have 100 collaborative accountable
care programs in place with one million customers by the end of 2014.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to
helping people improve their health, well-being and sense of security. All
products and services are provided exclusively by or through operating
subsidiaries of Cigna Corporation, including Connecticut General Life
Insurance Company, Cigna Health and Life Insurance Company, Life Insurance
Company of North America and Cigna Life Insurance Company of New York. Such
products and services include an integrated suite of health services, such as
medical, dental, behavioral health, pharmacy, vision, supplemental benefits,
and other related products including group life, accident and disability
insurance. Cigna maintains sales capability in 30 countries and jurisdictions,
and has approximately 71 million customer relationships throughout the world.
To learn more about Cigna®, including links to follow us on Facebook or
Twitter, visit

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health
care, and policy. Published by Project HOPE, the peer-reviewed journal appears
each month in print and online. Additional Web First papers published
periodically and health policy briefs published twice monthly at You can also find the journal on Facebook and Twitter.
Tap into with its iPad app. Read daily perspectives on Health Affairs Blog.
Download weekly Narrative Matters podcasts on iTunes.


Cigna Corporation
Mark Slitt, 860-226-2092
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