November 2019 HEALTH & WELLBEING

Case study: value based care

People’s preferences for accessing health care are shifting as new care options emerge and disrupt the status quo. However, the health care sector is struggling with the total cost of care, heightened by aging populations, an increasing burden of chronic illness, technological advances and pharmaceutical innovations.
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At Cigna, we understand the important missions our clients have and we’re privileged to be able to contribute to the vital work that they do. In order for staff members to be able to contribute to their organisations’ success, they must have access to quality health care and a wide range of services that help them stay healthy and productive. This is only possible with an affordable health care system. To achieve this, we must be mindful of managing costs and tackling wasteful health spending.


One key factor impacting rising health care costs in the USA is the predominantly fee-for-service reimbursement, where providers are paid for each service they provide. It’s a flawed system in which the supply creates the demand, creating incentives that drive up cost. Further, there’s no transparency to consumers on actual costs. This creates an inability to compare prices and shields them from caring about escalating costs. Not only is this model financially unsustainable, it leads to fragmented customer experience and inappropriate care use.

This is why Cigna Corporation set out to collaborate and align incentives with their network of physicians in the USA to change health care. The Cigna Collaborative Care programme introduced a new contracting strategy that reimburses based on value instead of volume. Under a value-based care model, providers are reimbursed based on the quality and the total cost of care they give their patients. Just as in any other industry, it holds the provider accountable for outcomes rather than simply paying them for the volume of services billed.

The goal of Cigna Collaborative Care is to deliver on a triple aim: better health outcomes, better costs and better experience. How does it achieve this goal? First, it incentivises high quality cost-efficient care to customers. Second, it shares timely and actionable data and insights with providers to help support clinical decisions and coordinate care. Third, it supports providers’ care plans using Cigna’s clinical programmes such as case management. Finally, it offers superior support for providers on all levels, both clinical and non-clinical. These value-based programmes have been successful in improving both affordability and quality.

Within value-based care, the programme has focussed efforts on collaborating with providers to improve their cost and quality where we have large volumes of customers. Cigna is increasingly focussing on how to guide customers to higher-performing providers who consistently deliver great care.


The path to value-based care is a journey. The Cigna Collaborative Care programme has already achieved great results so far; however, the work is not yet done. We continue to strategically expand collaborative efforts with the right hospitals, physicians and speciality practices to deliver higher quality, more affordable care to plan members. We continue to improve our data analytics and our ability to measure outcomes. And we continue to build innovative network solutions to meet our client needs. All our efforts are guided by our mission: to improve the health, wellbeing and peace of mind of those we serve.

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