Rush Health in Chicago and insurer Cigna have forged a deal gaining steam around the country: paying doctors to take better care of patients while spending less.
It's a tough feat keeping track of people unnecessarily racking up mileage in the ER or making sure they take their medications on time. But if Rush can hit certain quality measures and cut medical costs while doing so, they can essentially get a financial bonus from Cigna.
The arrangement also gives Rush a coveted peek into Cigna data on its patients that shows when they see doctors outside the network. It's a big perk as health systems are increasingly paid by insurers to focus on preventative care and keep their patients healthy, or potentially lose money if they don't.
“That's a big benefit in us partnering with (insurers) because they're always going to have more data on our patients that we have,” said Brent Estes, Rush Health president and CEO.
This is Cigna's sixth agreement with a health system in the Chicago area. It already has similar arrangements with Presence Health, the largest Catholic hospital network in the state, and Advocate Health Care, the largest overall hospital chain in Illinois, among others.
Nationwide, the Bloomfield, Conn.-based insurer has created about 150 of these deals since they began in 2008. Locally, it gives Cigna the edge over rivals if the carrier can show its increasingly cost-conscious employer customers they're saving them money by keeping their workers out of the hospital.
“At the end of the day, what are we keen on is delivering savings for our clients,” said Dr. Peter McCauley Sr., regional medical executive for Cigna's Northeast region, including the Midwest.
He estimates the program, called Cigna Collaborative Care, has saved about $50 million in the last three to four years nationwide by cutting medical costs.
The agreement with Rush Health began on April 1 and involves more than 4,000 patients insured by Cigna who already get the bulk of their primary care at Rush, a Chicago-based four-hospital network with about 1,400 doctors. The network is anchored by Rush University Medical Center, an academic medical center on the Near West Side.
The deal works like this: Cigna pays Rush an extra monthly fee to manage this group of patients. The idea is that the doctors are financially driven to make sure their patients don't miss a mammogram or fall through the cracks when they're discharged home from the hospital.
The monthly allotment can increase or decrease based on how good a job Rush doctors do, and if they lower medical costs at the same time.
Estes said the arrangement reflects a move for Rush toward more contracts with insurers that are based on quality of care rather than how many tests and services doctors perform.
“The more you do, the more efficient you can get” when taking care of patients, he said.
"Rush, Cigna hatch deal to boost patient care" originally appeared in Crain's Chicago Business.
