Becker’s Hospital Review: How Cigna is Working to Advance Collaborative Care

Washington, D.C. may be pumping the brakes on some value-based care initiatives, but more progressive commercial payers like Cigna are putting their weight behind advanced collaborative care models.

Lynn Garbee is the Senior Director of Strategic Reimbursement and Collaborative Care for Cigna. Prior to joining the health plan in 2013, she served as Assistant Vice President of Claim Analytics and Consulting for McKesson. Becker’s Hospital Review caught up with Ms. Garbee about her perspectives on innovation and opportunity in the realm of collaborative care for health insurers and how Cigna is working to better serve its provider partners.

Q: Where do you see an opportunity especially ripe for innovation in the health insurance market?

Lynn Garbee: I see many places for innovation. There are so many things we can do better as an industry. Cigna is known for innovation; we’ve been doing collaborative care models for 10 years and we continue to evolve our models as we learn. With all that experience, we see a lot of places we can do even more. Given Cigna has about 220 Accountable Care Organizations (ACOs),* one of the places we can innovate is understanding how to segment better to identify providers and groups we want to work with in a more collaborative way and those that are progressing and need more help. Similar to how we segment our markets, we are now segmenting our ACOs. That’s one way we can provide a differentiated experience and service for them, as well as our customers and clients.

Another great challenge is making complex health care systems simpler for our customers. Customers desire a lot of access and choice, and they love getting a big provider directory with lots of names and choices because it gives them comfort that they have options. But when customers get sick, they really want someone to help them get the right care, and that should be easy and simple. So our goal is to make it simple for customers to get good quality care for an affordable price. That’s where we should be innovating, in terms of how we can connect our customers to the right provider partners to help them get the right care. In doing that, there’s a couple areas where we are focusing.

Improving predictive analytics — which we’re investing a lot of resources in at Cigna. This way we can get further upstream in the patient journey and get to them before they start making choices about which providers they’re going to use and which treatment to seek. We can help patients earlier in their journey by moving them down paths with our high-performing collaborative care providers. Further, we’re focusing innovation around our specialty care providers. We realize specialists hold a lot of levers around the affordability of care; they choose whether patients go to the hospital, whether and where they perform surgeries, and what therapies they will invoke for patients. We’re working with our specialists to find ways we can pull them into collaborative care relationships and really create a medical neighborhood, or a hub-and-spoke model, with the ACO or our concierge OneGuide agents in the middle and preferred specialists around the outside.

I also observe more “front doors” to get access to care today. Millennials are choosing whether to go straight to specialists, to retail clinics or to use telehealth. The industry needs to innovate on avoiding creating a more fragmented world when there are more pathways through which to access care. The winners will figure out how to wrap together a patient’s health data, allowing patients to access care through any door they choose and still bring their data with them. That’s a great place for innovation.

Finally, being able to treat the customer as a whole person is an opportunity. Cigna is working to integrate behavioral and pharmacy together, but also thinking in a broader sense about any social determinant that might impact patient care. How do we help fill those care gaps so the patient gets the best care they can? For our client employers, it’s about the whole person getting back to work as a happy, healthy person as soon as possible.

Q: What do you consider your greatest achievement at Cigna?

LG: I came to Cigna 5 years ago because of the culture here. In my series of interviews, no less than three people told me that the philosophy here is that if we take care of the customer and put the customer at the center of everything we do, everything else will follow.

What I’m most proud of is that we’ve tremendously grown our programs since that time, but not lost sight of who we are – if anything we have rallied around it. I think we had about 60 ACO programs then and now we have about 220.* We had zero specialty programs and now we have 195.* And I feared that as we grew, that special way we care for our customers and work collaboratively with our providers to help our customers would be diluted. That has not happened. Our resolve to continuously place the customer at the center of what we do has been unwavering.

And now our collaborative programs are reaching many millions of customers, and we continuously strive to get our most at-risk and vulnerable customers into incentivized provider relationships where the provider is looking out for that customer’s quality of care and affordability. This is the fabric by which we create our products and know we will win.

Q: How is Cigna pursuing innovation in the realm of collaborative care?

LG: We’ve progressed our ACO programs in the last 10 years by segmenting them to figure out which programs are right for which types of providers. For example, we’re building programs for more advanced partners who are ready to be doing hard-target programs as well as programs for groups that are not yet ready for the full ACO program. Where it used to be a one-size-fits-all approach, now we have eight or nine varieties of models to meet providers where they are, which demonstrates our innovation.

We’ve also really been focused on specialty care in the last three years, trying to understand where total medical cost is being spent and how we can get more specialists involved in our collaborative care programs. We’ve specifically focused on building episodes of care in cardiology, orthopedics, gastroenterology, OB-GYN and oncology. We’re working to teach providers in these specialties the answer key – here’s how you can win in a shared savings program with us on these episodes of care. We’re leading the market in types and geographic spread of episodes of care.

Finally, we’re embedding things like behavioral health, pharmacy reporting and analytics into what we do with providers. We’re working with providers to treat the customer like a whole person by giving providers more integrated behavioral health and pharmacy information, and then pulling it all together as an ecosystem. We’re trying not to get caught up in an arms race about how many collaboratives we have or ACOs we work with, but instead being more thoughtful about how we segment ACOs and how we drive customers to the highest-performing collaboratives.

Q: Have there been any developments in health care in the past one to two years that surprised you or changed your way of thinking?

LG: I was anticipating more specialists would be ready to do to an episodes care approach. For the last year, I was waiting for the market to get there on episodes and specialty care, and I was a little discouraged they were slow on the uptake. But in the last 6-8 months, it’s turned around, and we’ve seen a lot more of our providers signing up for those programs. In general, I think there was an anticipation all value-based care would go faster. I think people have been watching Washington, D.C., and thought it would push the commercial world to go faster, but it hasn’t.

I firmly believe the pace is a little bit slower than expected, but we’re still going to get to the same destination. I think the endgame will still look like double-sided risk, it’s just how fast we’re going to get there. We just have to help providers get to that point and support them with the right solutions and tools to help them succeed in collaborative care. The end-state solution is still the same: we want to add value in health care by creating an environment where the provider, the customer and the client have aligned incentives and are winning equally through affordable, high-quality health care for our customers.

* Cigna internal analysis of existing arrangements as of July 2018. Subject to change.