CIGNA and ProHealth Physicians Create Enhanced Care Coordination Program.BLOOMFIELD & FARMINGTON, Conn. -- CIGNA CIGNA CG (Connecticut General Life Insurance Company) INA (Insurance Company of North America) (NYSE NYSE See: New York Stock Exchange :CI) and ProHealth Physicians, Inc., have expanded their longstanding relationship by implementing an enhanced care coordination care coordination Managed care 1. The brokering of services for Pts to ensure that needs are met and services are not duplicated by the organizations involved in providing care 2. program that includes pay-for-performance provisions and many of the features of a patient-centered medical home program. This is the first program of its kind in Connecticut. In a medical home model of primary care, a team of health professionals works together to provide enhanced patient care, including care coordination. This team may include a doctor, nurses, a health educator and other professionals who can provide individualized in·di·vid·u·al·ize tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es 1. To give individuality to. 2. To consider or treat individually; particularize. 3. care and health coaching. One of the goals of a medical home is to increase patient access to care, so ProHealth will help patients obtain services that are appropriate to that individual's age and situation, particularly patients with chronic conditions, such as heart disease or diabetes. CIGNA and ProHealth will each designate a care coordinator who will manage enrollment in and encourage use of disease management programs, consult on issues related to evidence-based medical guidelines A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions and criteria in specific areas of healthcare, as defined by an authoritative examination of current evidence , help improve adherence to overall care plans, analyze CIGNA's Well Informed report that identifies opportunities for potential care improvement, and coordinate communication with health plan participants Plan participants Employees or other beneficiaries who are eligible to receive benefits from a company's employee benefit plan. . ProHealth will earn higher reimbursements if it meets certain quality and efficiency targets. "CIGNA and ProHealth share common goals: to improve the quality and affordability of health care and increase patient satisfaction among the people we jointly serve," said Dr. Dick Salmon, a primary care physician and national medical director for CIGNA. "This new arrangement emphasizes the value of the primary care physician as the overall coordinator of their patients' health, and it will help increase the professional satisfaction and financial rewards for primary care physicians while achieving better outcomes for patients." "ProHealth remains committed to transforming the delivery of care and we are very pleased to be working with CIGNA to exemplify the improvements that can be attained through our collaboration," said Dr. Jim Cox-Chapman, chief medical officer of ProHealth. "This relationship will enable each of our organizations to contribute our unique strengths toward improving clinical outcomes, providing more comprehensive coordination of care, and applying the fundamental principles of the medical home model to increase access and reduce unnecessary duplication of services. Through the use of technology and enhanced data tools, the health care professionals in our practice will be enabled to make informed decisions, develop care plans, and offer educational materials that allow patients to better engage in self-care that extends beyond the office visit." ProHealth will develop and adopt care guides for five chronic conditions - diabetes, ischemic heart disease Ischemic heart disease Insufficient blood supply to the heart muscle (myocardium). Mentioned in: Myocarditis ischemic heart disease , congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , asthma and a fifth chronic condition that will be identified later. The arrangement also calls for ProHealth to use electronic health records and e-prescribing for greater efficiency and to increase patient access through extended daily hours, telephonic consulting on weekends and by providing weekend acute care. The care coordination program will focus on three categories of high risk participants initially: people at high risk for hospital readmission readmission Managed care The admission of a Pt to a health care facility for a condition–eg, stroke, MI, GI bleeding, hip fracture, cancer surgery, shortly after discharge. See nth admission. Cf Admission, Discharge. , those at high risk for health deterioration, and individuals identified through CIGNA's Well Informed reporting. ProHealth serves approximately 20,000 people in Connecticut who are enrolled in a CIGNA health plan and has 74 locations throughout the state. About CIGNA CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well-being and sense of security. CIGNA Corporation's operating subsidiaries provide an integrated suite of medical, dental, behavioral health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or , pharmacy and vision care benefits, as well as group life, accident and disability insurance, to approximately 46 million people throughout the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. and around the world. To learn more about CIGNA, visit www.cigna.com. To sign up for email alerts or an RSS feed Summaries of Web site content that are published in the RSS format for download. See RSS. of company news, log on to http://newsroom.cigna.com/section_display.cfm?section_id=18. About ProHealth Formed in 1997, ProHealth empowers primary care physicians to better serve patients through improved care processes and clinical reporting. While delivering superior patient care and service, ProHealth is also addressing the serious financial challenges facing patients and employers. |
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