Accountable care organization set up by Cigna, Atlanta physicians' group

Cigna HealthCare and the Atlanta-based Piedmont Physicians Group have launched an accountable care organization to cover 10,000 people insured by Cigna and receiving care from one of Piedmont's more than 100 primary care physicians.

"We believe that we can achieve better clinical outcomes by adopting a patient-centered model of primary care," said David Epstein, MD, Cigna's senior medical director for Georgia, in the Sept. 7 announcement. Those involved say this is the first accountable care organization in the state.

The endorsement of ACOs is a part of the new health system reform law, with hopes that increased coordination of care and a reduction in the duplication of services will rein in costs.

The law directed CMS to begin demonstration projects to test ACO projects nationwide, including the Medicare Shared Savings Program, scheduled to begin by Jan. 1, 2012. ACOs allow otherwise unrelated physicians, hospitals and other clinicians to work together to cut costs and improve quality of care.

Cigna is funding a registered nurse clinical care coordinator who will be employed by Piedmont. Physicians continue to receive usual fees for services provided but will get additional payment for care coordination and meeting quality and cost metrics.

"The status quo is totally unsustainable. Change has to come," said James Sams, MD, Piedmont's medical director. "An ACO is an opportunity to take back those parts of the profession that have been taken out of our grasp. This is an opportunity to be in control of those things we should control. Doctors are nervous about change, but we cannot let that hold us back."

Patients have been sent letters informing them of this change and their responsibilities, such as keeping appointments and ensuring that medication records are complete. There is no change in how they access specialty care.

Physicians with Piedmont Physicians Group, which is part of Piedmont Healthcare, hope it will qualify for ACO designation under Medicare and Medicaid.

"If it's successful, it could expand to include other patient populations," Dr. Sams said.

Cigna is running programs in several other states and will evaluate the effectiveness of this one after it has been running for a year.

The American Medical Association lists resources to help physicians prepare for payment reform on its website dedicated to the subject (link).