The Jackson Clinic Shows Improved Quality, Lower Costs in Cigna’s Collaborative Accountable Care Program

JACKSON, Tenn. & BLOOMFIELD, Conn.--First-year results from Cigna's (NYSE: CI) collaborative accountable care initiative with The Jackson Clinic indicate that the program is showing progress toward achieving the “triple aim” of improved health, affordability and patient experience. The Jackson Clinic serves over 5,500 individuals covered by a Cigna health plan and has shown significantly positive results in delivering quality care while controlling total medical cost trend.

“Providing the highest possible quality of care – medical care that exceeds the expectations of our patients throughout rural West Tennessee – that is our goal,” said Dr. Bill Mariencheck, Clinic President. “It was apparent from our first meeting with Cigna about its Collaborative Accountable Care program that it was well-thought-out, and it provided a solid foundation for us to integrate the infrastructure put in place at The Clinic over the past decade to support well-coordinated, efficient care delivery.”

Cigna quality of care measures compare how well a physician practice follows guidelines for evidence-based medicine relative to other practices in the same geographic area (market) across the patients with Cigna coverage. During calendar year 2012, the Jackson Clinic outperformed its peers on a number of important measures:

• 19% better than market for annual eye exams for people with diabetes
• 25% better than market for annual screenings for kidney disease for people with diabetes
• 7% better than market for breast cancer screenings
• 50% better than market for adolescent well-care visits

“We are happy with the results of our collaborative accountable care partnership with Cigna, and encouraged,” said Carl Rudd, Jackson Clinic Administrator for nearly 40 years. “We expected to use the program to prepare our staff for health care reform changes. Even if it took more than one year to meet the quality and efficiency goals we set, our participation would prepare us for the significant changes ahead. It definitely required us to change the internal processes for delivering medical services and required the organization to look for combinations of quality and efficiency that could guarantee our patients the results they expect of The Jackson Clinic. Our providers and staff stepped up to the challenge as they always have.”

“This is a physician practice that truly understands the value of collaboration between doctors and the health plan, to the benefit of their patients and local employers, who can enjoy better care and lower medical costs through this program,” said Renee McLaughlin, M.D., Cigna's senior medical director for Tennessee.

Cigna also measures cost-efficiency by comparing a physician practice’s total medical cost trend relative to other practices in the same geographic area (market). During calendar year 2012, The Jackson Clinic experienced an overall total medical cost trend of nearly five percent lower than the local market.

A number of factors contributed to these results, including high referral rates to Cigna Care Designated specialists (physicians in certain specialties who meet/exceed Cigna-specific quality and cost-efficiency criteria), a focus and dedication to improving inpatient hospital costs, and helping frequent emergency room users receive the care they need in the most appropriate setting. During 2012, The Jackson Clinic had:

• 10.5% better inpatient hospital cost trend compared to market
• Half as many frequent emergency room users compared to market, resulting from additional Convenient Care locations and extended office hours
• 70% better referral rate to Cigna Care Designated specialists compared to market

What makes the program work? A registered nurse, employed by The Jackson Clinic, serves as a clinical care coordinator and helps patients with chronic conditions or other health challenges navigate the health care system. The care coordinator is aligned with 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 individual.

“Our doctors – especially our primary care physicians – immediately grasped the benefits of a ‘care team,’” said Sarah Bynum, MHA/INF, RN, who directs The Clinic’s new Clinical Informatics and Population Health Management Department. “Because of our electronic health record, we had the data. With Cigna’s help, we used the data to reach out to patients about preventive care and chronic disease management. We found patients to be very receptive – they want to be cared for well.”

Other factors that also contributed to The Jackson Clinic’s positive results include:

• Participation in a “Transition of Care” pilot, in which The Jackson Clinic’s embedded clinical care coordinator reaches out to patients following hospital discharge to schedule them for a visit with their primary care doctor within seven days;
• Increased office hours and additional locations to give patients an alternative to the emergency room when seeking care;
• Educational postcards available at Jackson Clinic locations explaining when it may be appropriate to use urgent care facilities or the emergency room and how patients can contact Jackson Clinic to set up a same-day appointment;
• The introduction of services at a skilled nursing facility, as an alternative patient care setting to avoid extended inpatient hospital stays when appropriate; and,
• An effective hospitalist program focused on frequent emergency room users, with the clinical care coordinator reaching out to patients to provide guidance and education on the most appropriate care settings.

“I think that all health care providers – physicians, nurses, and their assisting personnel – aspire to provide excellent care, and to be perceived as superb care-givers. Our providers don’t seek to be just average,” said Ms. Bynum. “This commitment to excellence – individually and organizationally – has been a critical factor in The Clinic’s success over the years.”

The principles of the patient-centered medical home are the foundation of Cigna's collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with physician practices. Cigna has 66 collaborative accountable care initiatives in 26 states, encompassing more than 700,000 commercial customers and more than 27,000 doctors, including more than 12,500 primary care physicians and nearly 14,500 specialists. Cigna launched its first collaborative accountable care program in 2008 and its goal is to have 100 of them in place with one million customers in 2014.

Collaborative accountable care is one component of the company’s approach to physician engagement for health improvement, which also includes Cigna-HealthSpring’s care model for Medicare customers. Taken together, these 231 programs in 31 states reach more than one million customers and have nearly 55,000 participating doctors, including nearly 19,000 primary care physicians and nearly 36,000 specialists.

About The Jackson Clinic

Established in 1950 by five medical and surgical specialists, The Jackson Clinic was the first multi-specialty group practice in Tennessee. Today, it is a professional association of physicians devoted to the private group practice of medicine. The Clinic has a long history of innovation in West Tennessee: first extended-hours Convenient Care clinic location in 1986; first hospitalist program in 1997; first comprehensive electronic medical record in 1999. Clinic physicians are now poised to lead the medical community of West Tennessee through a period of unprecedented health system reform. At The Jackson Clinic, our 21^st Century goal is the same as it was in the last century: to provide the highest level of medical care by integrating clinical practice, current technology, and research, in an environment that is comfortable to our patients.

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 80 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.