Health & Wellness

Cigna and Summit Medical Group Join in Collaborative Accountable Care Program

December 12, 2012 at 11:59 PM

BERKELEY HEIGHTS, NJ – In its ongoing quest to reduce the cost of health care, Summit Medical Group today announced a new partnership with Cigna.

The joint program between Summit Medical Group (SMG), New Jersey's largest physician-owned multispecialty practice, and Cigna is a collaborative accountable care program to achieve the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction, said Jeffrey Le Benger, chairman and chief executive officer of SMG.

The program, which took effect Dec. 1, benefits approximately 10,000 individuals covered by a Cigna health plan who receive care from more than 300 Summit Medical Group providers. SMG treats patients at its 42-acre main campus in Berkeley Heights as well as at 20 area satellites in Berkeley Heights, Bayonne, Morristown, Millburn, Short Hills, Springfield, New Providence, Warren, Westfield and West Orange.

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“Summit Medical Group has long embraced the coordinated care model as the best way to deliver quality care and patient satisfaction,” Le Benger explained. “Our emphasis on preventive care and collaboration makes Cigna a natural partner for us as we work together to improve the patient experience and enhance the health care delivery system.”

Through its electronic health record, Summit Medical Group doctors monitor and coordinate all aspects of an individual’s medical care. In this arrangement with Cigna, patients will continue to go to their current SMG physician and automatically receive the benefits of the program.

There also are no changes in any plan requirements regarding referrals to specialists. While all patients will benefit from this initiative, patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.

Le Benger said Summit Medical Group has long believed that the only sustainable way to control rising medical costs is by improving patient health. Not only does SMG help prevent health problems before they start, but when people do get sick, they shorten the amount of time they’re hospitalized or how often they visit the emergency room by ensuring proper follow up after a patient is discharged, whether they’re sent home or a rehab facility or nursing home.

“Helping people reduce their health risks, preventing health problems before they happen, stopping disease before it progresses and helping to ensure the right care, at the right time, in the right place are all at the heart of our collaboration with Summit Medical Group,” said Charlie Catalano, president and general manager for Cigna in New Jersey.

Cigna's collaborative accountable care programs work to accomplish the same population health goals as accountable care organizations, or ACOs:

  • Improved access to care 
  • Increased emphasis on preventive care 
  • Greater care coordination and patient engagement 
  • Better management of chronic illness (or chronic diseases)
  • Lower hospital readmissions
  • Reduced health care costs through alignment of payment with improved outcomes, quality and value.

Critical to the benefits of the Cigna-Summit program are registered nurses, employed by Summit Medical Group, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system.

Le Benger said using patient-specific data from Cigna and from Summit Medical Group’s electronic health record, care coordinators identify patients discharged from the hospital who might be at-risk for readmission, as well as patients who may be overdue for important health screenings or who may have a medication-related issue. Part of Summit Medical Group's physician-led team, care coordinators help patients get the follow-up care or screenings they need. The care coordinators are aligned to a team of Cigna case managers to ensure a high degree of collaboration between Summit Medical Group and Cigna that ultimately results in a better experience for the individual.

Care coordinators can also help patients schedule appointments, provide health education and inform patients about SMG’s clinical programs (Freedom from Smoking Program, weight management, Behavioral Health Program, or the Diabetes Live Well Program) as well as Cigna’s health, wellness and chronic condition management programs available to them through their employer’s health plan.    

Cigna will compensate Summit Medical Group physicians for the medical and care coordination services they provide. Additionally, SMG physicians may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.

“We’re the only medical group in New Jersey to do this,” Le Benger said. “Individual doctors can’t do this. New Jersey’s hospitals are over-bedded, and we are finding ways to keep people out of the hospital, and to keep the cost of healthcare down. That’s what we’ve done here.”

This newest initiative in New Jersey builds on Cigna's and SMG's commitment to change the health care delivery system from one that focuses on paying for volume to a system that rewards value and quality of outcomes. Cigna is now engaged in 42 collaborative accountable care initiatives in 18 states, encompassing more than 390,000 Cigna customers and more than 5,500 primary care physicians. 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 by the end of 2014. Summit Medical Group has launched similar initiatives with other major insurance carriers in New Jersey. 

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