As our CAN and IPN networks enter into value-based agreements with insurance companies, it is essential that we have engagement from the physicians participating in these agreements, along with all office staff represented. Value Based agreements represent the movement from fee for service to fee for value, where reimbursement opportunities from payers is evolving. These agreements offer 'shared savings" over and above negotiated fee for service rates.
This payment for quality and outcomes movement is across all segments of healthcare -Medicare, Medicaid, and Commercial patients.
We receive calls daily from physicians asking to improve their reimbursement rates with select insurance companies, or stating they have been termed from a specific network, or requesting they be added to specific product lines from an insurance carrier. The days of requesting or begging for improved fee for service rates are pretty much non-existent today. Payers are looking for high performing physicians, based on both quality and cost. Their clients, employers and consumers, are demanding it. Payers are being judged on their premium rates, co-pays, co-insurance, and deductibles when comparing benefits, as well as their physician and healthcare provider networks. Double-digit rate increases are the norm today, and employers and consumers are looking for alternative avenues for healthcare.
As you all know, we currently have a Cigna CAC contract in 4 counties, and are expanding 4 additional counties on April 1. We have a tremendous opportunity to improve quality and cost for these patients, while also improving reimbursement for our physicians. We are in negotiation with other major payers as well, and are very close to finalizing them.
Our challenge is engagement and execution by our physician practices. Our CAN/IPN team works daily to monitor, analyze, and relate key areas of patient care to our physicians and practice staff. We receive a daily ecommerce file from Cigna relaying ER visits, Admissions, and Discharges. Our Embedded Care Coordinator Nurse (ECC) contacts these patients providing assistance as needed to the patient and families, while also alerting our practices, when appropriate. We receive monthly analytics reporting by practice on performance and care gap opportunities. It is essential, when you receive requests from our IPN team, you respond to these requests, whether they are .administrative or clinical in nature. Our shared savings depends on our reporting ability to meet certain quality metrics for the patients assigned to our CAC agreement. If you have any questions, please contact the IPN office@ 407-475-9213 x 501.
This process will become more prevalent as we continue to build our integrated network and "independent delivery system" with our CAN and IPN physicians. We will be implementing a "mobile app" designed to make easy referrals between all of our physicians and independent ancillary providers. Stay tuned, it is coming very soon.
We are currently working on closing specific care gaps with our assigned Cigna patients and this must be completed by March 31. Please ensure that your staff is receptive when our IPN & Cigna teams are in communication.
More to come on our evolution, as we move from an IPA network to a fully clinically integrated network. Thank you for your support in preserving and protecting the independent practice of medicine.