Featured in Health Business Daily, July 25, 2017

Cigna Teams Up With Fresenius on Plan’s ESRD Value-Based Model

Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, specialty pharmacies, pharma companies, providers and employers contain costs and improve outcomes related to high-cost specialty products. Subscribe today!

By Angela Maas, Managing Editor
February 2017Volume 14Issue 2

An earlier version of this story incorrectly attributed statistics for Medicare beneficiaries with chronic kidney disease to beneficiaries with end-stage renal disease (ESRD). People with ESRD account for 1% of the Medicare population, but the spending on their care is more than seven times what is spent on an average Medicare beneficiary. This version has been corrected.

Cigna Corp. continues to broaden its approach to value-based care, in line with the plan’s commitment to have 50% of its reimbursement in alternative payment models and 90% in value-based arrangements by 2018. The company said Feb. 7 that it had expanded its Cigna Collaborative Care model to include people with end-stage renal disease (ESRD) undergoing dialysis.

Cigna is working with Fresenius Medical Care North America (FMCNA) and its affiliate Fresenius Health Partners on the nationwide initiative that seeks to improve patients’ health, affordability and satisfaction, as well as providers’ experience. Cigna Collaborative Care already has programs focused on conditions such as heart disease and cancer (SPN 10/16, p. 1), but this is the first one to cover that patient population.

Cigna will reimburse FMCNA for the dialysis services it provides the plan’s members, and Fresenius Health Partners will “assume separate responsibility to provide management of medical costs and to improve patient outcomes,” according to the companies. FMCNA may receive additional reimbursement if it achieves certain goals provided that the dialysis clinics either maintain or improve their CMS star ratings in the Dialysis Facility Compare quality rating.

Specialty Pharmacy News

Specialized Nurses Work With Doctors on Care

Specialized nurses and service coordinators from FMCNA will coordinate patients’ care with their physicians, “identify opportunities to engage with them to avoid complications and unnecessary services, and coordinate services with Cigna medical and behavioral case management,” say the companies.

“By working together to coordinate and expand access to care, we can help people get the right care at the right time in the right setting. This enables us to achieve all the elements of what we call the ‘quadruple aim’ — better health, affordability, patient satisfaction and provider experience,” says Scott Josephs, M.D., Cigna vice president and national medical officer.

Asked how the agreement came about, William McKinney, president, Integrated Care Group at Fresenius Medical Care, says that “Cigna has been a long-standing partner with FMCNA for dialysis services, and its Cigna Collaborative Care initiative aligned very well with our own move towards value-based care. These pieces came together naturally through discussions and relationships already established between our companies.”

“The agreement is structured so that it can continue for as long as it adds value to Cigna’s clients and our mutual members/patients,” he tells AIS Health. “FMCNA really sees this sort of arrangement as a core part of how we contribute to the health care system going forward.”

The condition is well-suited for this type of value-based approach because “ESRD patients are a high-cost, high-need population and among the frailest in the Medicare program,” explains McKinney. “Although ESRD patients account for only 1% of the Medicare population, their cost of care is more than 7 times that of an average Medicare beneficiary.”

ESRD Is Well-Suited for Value Approach

The condition is well-suited for this type of value-based approach because “ESRD patients are a high-cost, high-need population and among the frailest in the Medicare program,” explains McKinney. “Although ESRD patients account for only 1% of the Medicare population, they represent more than 20% of the spending in the traditional 65+ beneficiary segment and nearly 45% of the spending among beneficiaries younger than 65.”

Although McKinney declines to give specifics on quality measures and specific outcomes they’re trying to achieve, he says that “Cigna will evaluate outcomes for a number of quality measures which correlate directly to the total cost of care and overall patient experience. Both Cigna’s and FMCNA’s clinicians feel comfortable that the measures we’ve established and the associated clinical interventions can improve the quality of life for our patients. An outcome of this, we believe, will be a significant cost savings to Cigna’s clients and our mutual members/patients.”

For example, one of the goals of the initiative is to keep patients healthier by offering them additional access to dialysis at Fresenius Kidney Care outpatient facilities, which in turn hopefully results in decreased visits to the emergency room and hospital admissions.

“At the end of the day, if we can keep our patients healthy and avoid unnecessary admissions and readmissions, our patients will win, and our program will be successful,” says McKinney.

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