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Cigna Partners with Scripps Health in Pay-for-Performance Model

Scripps Health and Cigna have created an alliance through a pay-for-performance model to sell HMO health plans among San Diego employers.

By Vera Gruessner

- The national health insurer Cigna announced in a company press release yesterday that it will be partnering with the nonprofit healthcare delivery system Scripps Health through a pay-for-performance contract to provide employers in the San Diego area medical products meant to improve accessibility, quality, and affordability.

Value-Based Care Reimbursement

Employers with at least 100 employees will be provided HMO health plans called Scripps Select HMO by April 1, 2017. Employers will have a choice of fully-insured plans or other types of funding structures. The partnership between Cigna and Scripps Health will be on a pay-for-performance platform and will include financial incentives to improve quality of care and smarter utilization of medical services.

The key to this partnership is to enhance patient health outcomes as well as offer more affordability and value to workers and employers. The pay-for-performance partnership will offer employers in the San Diego area to purchase Scripps Select HMO plan. Employers with workers in multiple markets, however, will be able to purchase extra coverage from Cigna as well.

For example, employers located in San Diego but with a workforce in other cities and states will be able to offer health insurance to those employees through additional coverage options from Cigna.

“Our joint approach to health care is different from a traditional one because it’s based on very close integration between Cigna and Scripps Health,” said Gene Rapisardi, President and General Manager for Cigna's Southern California and Nevada markets.

“We have a unified purpose – to put the customers we serve at the center of all we do, and help them access affordable and personalized care. We recognize that health care is local, so our goal is to create the premier local plan that exceeds the expectations of San Diego employers and their employees,” Rapisardi continued.

The health plans sold through the pay-for-performance partnership will cover a wide array of services including pharmacy, nurse care management, mental and behavioral health, health coaching services and general medical care. Coverage for vision, dental,  group life and disability plans is also available at Cigna for an extra cost.

The pay-for-performance contract relies on boosting care coordination and using health improvement programs. Cigna members will benefit from the partnership by having easier navigation for visiting specialists and obtaining screenings or laboratory work. Members will have access to new wellness tools and an easier time scheduling clinician appointments, according to the press release.

“With providers, payers, employers and individuals working together, Scripps and Cigna are building an innovative health care model that encourages care coordination to achieve common goals – better health, more affordability and an ideal patient experience,” said Chris Van Gorder, President and CEO of Scripps Health.

The pay-for-performance partnership is meant to help reach greater savings as well as improve patient satisfaction and health outcomes. Previously, Cigna and Scripps Health worked together through Cigna Collaborative Care, a value-based care platform.

“We see this alliance as an extension of our earlier collaboration with Scripps,” Rapisardi said.

Another area where Cigna has pursued value-based care reimbursement is its new service company CareAllies, which will work closely with provider organizations to boost quality of care and patient outcomes.

“Cigna has been a leader in value-based care reimbursement since 2008 and we are well on the way to having value-based reimbursements represent the majority of our arrangements with providers by 2018,” Mark Slitt, Spokesman and Public Relations Manager at Cigna, told last May.

“This is fundamentally changing the relationship between payers and providers by making the relationship much more collaborative. There is now much more focus on working together to improve quality and affordability so that the customers/patients we jointly serve have better outcomes and enjoy a better experience.”

Other health insurance companies would benefit from following in the footsteps of Cigna and pursuing pay-for-performance contracts in order to gain greater financial savings, improve population health outcomes, and achieve greater patient satisfaction.


Dig Deeper:

Time, Commitment Required for ACO, Value-Based Care Success

How Payers Should Prepare for Value-Based Reimbursement


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