RCCA will designate a registered nurse or an advanced care practitioner as the group’s oncology care coordinator who will assist patients and ensure their care is properly coordinated.
Cigna will compensate the medical group with a one-time care management payment for each of its patients undergoing chemotherapy treatment. This incentive reimburses the group for its additional oversight and management of patient care.
Cigna will also provide a single point of contact – a collaborative care associate – who will assist the medical practice’s oncology care coordinator with information about a Cigna customer’s benefits. Cigna will also provide oncology case management services for customers and their families who might need additional education or coordination of resources outside of the oncology practice.
Cigna plans to launch a similar program soon with an oncology practice in Florida, and expects to have up to eight of these arrangements in place by the end of 2015.
“We’ve seen great results from our collaborative care arrangements with large physician groups,” said Ronald Menzin, M.D., senior medical director for Cigna in New Jersey. “Now we’re applying that successful model – which includes a care coordinator employed by the medical practice, and incentives that compensate physicians for the value of the care they deliver – to drive similar improvements in quality and cost of oncology care.”
“The need to bring value to the health care system by avoiding under and over utilization is essential to optimize patient outcomes and reduce overall cost of care,” said Andrew Pecora, M.D., president of Regional Cancer Care Associates. “Establishing this relationship with Cigna, and using new technologies like COTA that precisely measure variance in clinical and cost outcomes, will improve cancer care so that we can deliver better quality of life and a better experience for our patients each time they interact with our clinical team.”
The care coordination component of Cigna Collaborative Care for oncology consists of six components, with RCCA managing the treatment and Cigna providing extra support and information to help:
· Informed decision making regarding treatment, which helps patients and care givers understand when therapy is or isn’t curative; provides treatment options and information about toxicity, cost and effectiveness of treatment; initiates conversations with patients and families about functional status, advanced care, end of life wishes; and facilitates access to palliative and/or hospice care when appropriate.
· Holistic evaluation of the symptoms and quality of life at each encounter.
· Proactive care coordination, which includes inpatient management and discharge planning for all admissions; care planning and post therapy outreach to ensure individuals have access to prescriptions, understand side effects and know when and who to call if there are changes in health status; patient education and help with future appointments.
· Hospice care coordination, which assists patients and families with end of life planning and palliative care services.
· Access and referral coordination, where the oncologist and the collaborative care coordinator are the primary contact for the patient while in treatment, with 24×7 access to a practice affiliated clinician, and proactive communication with the individual’s primary care physician and other health care providers.
· Transition of care back to the primary care physician by providing the patient and the primary care physician with a discharge summary and discharge plan which includes diagnosis, summary of clinical status, list of medications and recommendations for ongoing observation.