Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter
designed to help health plans, specialty pharmacies, pharma companies,
providers and employers contain costs and improve outcomes related to high-cost
specialty products.
By Angela
Maas, Managing Editor
February 2017 Volume 14 Issue 2
An earlier version of this story incorrectly attributed statistics
for Medicare beneficiaries with chronic kidney disease to beneficiaries with
end-stage renal disease (ESRD). People with ESRD account for 1% of the Medicare
population, but the spending on their care is more than seven times what is
spent on an average Medicare beneficiary. This version has been corrected.
Cigna Corp. continues to broaden its approach to value-based care,
in line with the plan’s commitment to have 50% of its reimbursement in
alternative payment models and 90% in value-based arrangements by 2018. The
company said Feb. 7 that it had expanded its Cigna Collaborative Care model to
include people with end-stage renal disease (ESRD) undergoing dialysis.
Cigna is working with Fresenius Medical Care North America (FMCNA)
and its affiliate Fresenius Health Partners on the nationwide initiative that
seeks to improve patients’ health, affordability and satisfaction, as well as
providers’ experience. Cigna Collaborative Care already has programs focused on
conditions such as heart disease and cancer (SPN 10/16, p. 1), but
this is the first one to cover that patient population.
Cigna will reimburse FMCNA for the dialysis services it provides
the plan’s members, and Fresenius Health Partners will “assume separate
responsibility to provide management of medical costs and to improve patient
outcomes,” according to the companies. FMCNA may receive additional
reimbursement if it achieves certain goals provided that the dialysis clinics
either maintain or improve their CMS star ratings in the Dialysis Facility
Compare quality rating.
Specialized Nurses Work With Doctors on Care
Specialized nurses and service coordinators from FMCNA will
coordinate patients’ care with their physicians, “identify opportunities to
engage with them to avoid complications and unnecessary services, and coordinate
services with Cigna medical and behavioral case management,” say the companies.
“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,”
says Scott Josephs, M.D., Cigna vice president and national medical officer.
Asked how the agreement came about, William McKinney, president,
Integrated Care Group at Fresenius Medical Care, says that “Cigna has been a
long-standing partner with FMCNA for dialysis services, and its Cigna
Collaborative Care initiative aligned very well with our own move towards
value-based care. These pieces came together naturally through discussions and
relationships already established between our companies.”
“The agreement is structured so that it can continue for as long
as it adds value to Cigna’s clients and our mutual members/patients,” he tells
AIS Health. “FMCNA really sees this sort of arrangement as a core part of how
we contribute to the health care system going forward.”
The condition is well-suited for this type of value-based approach
because “ESRD patients are a high-cost, high-need population and among the
frailest in the Medicare program,” explains McKinney. “Although ESRD patients
account for only 1% of the Medicare population, their cost of care is more than
7 times that of an average Medicare beneficiary.”
ESRD Is Well-Suited for Value Approach
The condition is well-suited for this type of value-based approach
because “ESRD patients are a high-cost, high-need population and among the
frailest in the Medicare program,” explains McKinney. “Although ESRD patients
account for only 1% of the Medicare population, they represent more than 20% of
the spending in the traditional 65+ beneficiary segment and nearly 45% of the
spending among beneficiaries younger than 65.”
Although McKinney declines to give specifics on quality measures
and specific outcomes they’re trying to achieve, he says that “Cigna will
evaluate outcomes for a number of quality measures which correlate directly to
the total cost of care and overall patient experience. Both Cigna’s and FMCNA’s
clinicians feel comfortable that the measures we’ve established and the
associated clinical interventions can improve the quality of life for our
patients. An outcome of this, we believe, will be a significant cost savings to
Cigna’s clients and our mutual members/patients.”
For example, one of the goals of the initiative is to keep
patients healthier by offering them additional access to dialysis at Fresenius
Kidney Care outpatient facilities, which in turn hopefully results in decreased
visits to the emergency room and hospital admissions.
“At the end of the day, if we can keep our patients healthy and
avoid unnecessary admissions and readmissions, our patients will win, and our
program will be successful,” says McKinney.
https://aishealth.com/archive/nspn0217-05?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=114641777
No comments:
Post a Comment