February 7, 2017 –
The program is part of Cigna Collaborative Care, a value-based model that uses incentives to engage health care providers and helps drive improved health, affordability, patient satisfaction and provider experience. Cigna Collaborative Care initially focused on large primary care physician groups and later expanded to include hospitals, smaller primary care practices and specialists, such as doctors and other providers who treat cancer, heart disease, and now kidney disease.
Under the new initiative, FMCNA will continue to be paid for the kidney dialysis services it provides to its Cigna patients, while its affiliate, Fresenius Health Partners, will assume separate responsibility to provide management of medical costs and to improve patient outcomes.
Implementing its proprietary care coordination model for this purpose, FMCNA may be eligible for additional reimbursement if it achieves these goals so long as the dialysis clinics maintain or improve their star ratings in the Centers for Medicare & Medicaid Services (CMS) Dialysis Facility Compare (DFC) quality rating. Cigna will evaluate outcomes for a number of quality measures which correlate directly to the total cost of care and overall patient experience.
One of the program’s goals is to reduce emergency room use and hospital admission for dialysis by keeping patients healthier and providing them with additional access to dialysis at Fresenius Kidney Care outpatient facilities as needed.
“By working together to coordinate and expand access to care, we can help people get the right care at the right time in the right setting. This enables us to achieve all the elements of what we call the ‘quadruple aim’ – better health, affordability, patient satisfaction and provider experience,” said Scott Josephs, M.D., Cigna vice president and national medical officer.
As part of the agreement, specialized nurses and service coordinators from FMCNA’s Care Navigation Unit (CNU) will coordinate care with a patient’s current doctors, identify opportunities to engage with them to avoid complications and unnecessary services, and coordinate services with Cigna medical and behavioral case management. Thus, FMCNA will have an expanded assessment role while delivering care and will help manage the patient’s medical needs both in and outside the dialysis clinic.
“We are proud to collaborate with Cigna in this joint effort to improve the quality and affordability of care. With the CNU, we are focusing on the unique clinical and psycho-social needs of each patient and able to foresee issues before they arise, helping patients, their families and their providers respond more quickly as they happen,” said William McKinney, president of FMCNA’s Integrated Care Group. “This heightened level of service is part of our commitment to improve the quality of life for every patient, every day.”
“Innovating the care and management of patients with kidney failure is at the core of what we do, and it is heartening to collaborate with Cigna, an organization that is similarly dedicated to making the health care system better,” said Bill Valle, FMCNA’s chief executive officer. “More than ever, chronically ill patients, such as those with kidney failure, deserve coordinated and integrated care, and in partnering with Cigna, we will bring to its customers a demonstrated ability to improve patient experience and health outcomes and reduce costs.”
The new initiative with FMCNA is Cigna’s first value-based arrangement with kidney disease specialists. It is consistent with Cigna’s commitment to have 50 percent of its reimbursements in alternative payment models and 90 percent in value-based arrangements by 2018.
Value-based arrangements come in a variety of forms that reward physicians and other providers for the quality and the value of the care they provide. In a pay-for-value model, they are compensated for achieving specific quality and cost targets. In an episodes-of-care arrangement, they are compensated for all of the care they provide related to a specific procedure – for example, a hip replacement or other surgery – including a defined time prior to the procedure, the procedure itself, recovery and follow-up care for a defined time after the surgery.