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A care collaboration in Santa Clara County is reporting promising results, touting "better healthcare quality for nearly 18,000 Silicon Valley residents while achieving significantly better affordability."

The collaboration between Cigna and Santa Clara County IPA (SCCIPA) uses patient-specific data from Cigna to help identify individuals being discharged from the hospital who might be at risk for readmission, as well as people who may be overdue for important health screenings or who may have skipped a prescription refill. The physician-led care team also helps patients get the follow-up care or screenings they need, identifies potential complications related to medications and helps prevent chronic conditions from worsening.

SCCIPA beats the market in affordability with total medical costs that are 18% below market average, and the medical group’s cost trend was 2.6% lower than the market trend during the period ending Sept. 30, 2018, according to CIGNA.

At the same time, the group’s quality score improved by double digits – nearly 20 percentage points, led by better care of patients with cardiac conditions, diabetes, depression and those requiring specific preventive screenings.

Numerous factors contributed to SCCIPA’s performance results compared to the market, including:

  • Hospital readmissions were 23% lower than market

  • Inpatient admissions among all services were 10% lower than market

  • Emergency room visits were 9% lower than market

  • Advanced imaging (CT scans and MRIs) were used 32% less than market

  • Inpatient total medical cost (per Cigna customer per month) was 20% lower than market

“As a risk-bearing network of more than 800 physicians, we’re very pleased with these positive results,” said John Kersten Kraft, MD, president of SCCIPA. “SCCIPA is devoted to improving the measurable quality of medical intervention received by our patients while controlling the cost of their care. We value our strong and exceptionally collaborative relationship with Cigna. Without this relationship, these results could not be achieved. Together, we are having a very positive impact on the health of our patients.”

Since Cigna began collaborating with SCCIPA in 2014, the group has demonstrated some of the most consistent performance, not only among other medical groups in Northern California and Cigna's Western Region, but also among the more than 225 Collaborative Care arrangements Cigna has with provider groups nationwide. In 2018, SCCIPA was the top performing Cigna Collaborative Care group nationally.

“When health plans and healthcare providers work together toward a common goal, the result is better health and affordability for the people we jointly serve,” said Ken Phenow, MD, MPH, market medical executive for Cigna in Northern California. “We congratulate Santa Clara County IPA for its laser focus on quality improvement that drove these outstanding results.”

In addition to its Collaborative Care arrangement with Cigna, SCCIPA is also part of an alliance between Cigna and Good Samaritan Health System, which includes Regional Medical Center of San Jose and Good Samaritan Hospital. The alliance launched in January 2018 and offers a customized network of primary care doctors, specialists and hospitals that provide high-value care.

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