Cigna and ProHealth Physicians Enhanced Care Coordination Program

Program Location: 
Farmington, CT
Number of Practices: 
Payer Type: 

Reported Outcomes


In October 2009, Cigna and ProHealth Physicians, Inc., implemented an enhanced care coordination program that includes pay-for-performance provisions and many of the features of a patient-centered medical home program. In accordance with one of the goals of a medical home, to increase patient access to care, 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 to manage enrollment in and encourage use of disease management programs, consult on issues related to evidence-based medical guidelines, 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.

ProHealth will develop and adopt care guides for five chronic conditions - diabetes, ischemic heart disease, congestive heart failure, 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, those at high risk for health deterioration, and individuals identified through Cigna’s Well Informed reporting.

Payment Model: 

Cigna will compensate the ProHealth Physicians for the medical and care coordination services it provides. Additionally, the medical group may be rewarded through a “pay for performance” structure if it meets targets for improving quality and lowering medical costs.

Fewer ED / Hospital Visits: 

Cigna press release (May 2015)

  • ER use is 7 percent lower than market

Improved Health: 

Cigna press release (May 2015)

  • 9 percent better than market on diabetes measures
    • due to diabetic patients receiving testing and treatment according to the recommended guidelines.
Other Outcomes: 

Cigna press release (May 2015)

  • 37 percent referral rate to preferred providers of CT scans and MRI outperforms the market
  • use of advanced imaging is 16 percent better than market.
Last updated June 2015
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