Academy, CIGNA Find Common Ground

At the Academy's invitation, top-level CIGNA HealthCare executives recently visited AAFP headquarters in Leawood, Kan., to talk frankly with AAFP leaders and staff members about issues on which the Academy wanted clarification. By all accounts, the June 15 meeting proved fruitful.

"We greatly appreciate both the hospitality and the collaborative approach that the senior leaders of the Academy took with us," said Andrea Gelzer, M.D., CIGNA's senior vice president of clinical public affairs, in a follow-up interview. "We look forward to a collaborative relationship going forward to address issues of mutual concern to CIGNA, our members and (AAFP's) physician members."

AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., agreed. "It was a very productive meeting, especially in the sense that a lot of the information we were seeking was anticipated and volunteered by CIGNA," she said. "Our guests came prepared to discuss issues with us, and CIGNA's medical director for their tri-state region (Connecticut, New Jersey and New York) -- where blended rates have been in effect since 2000 -- attended the meeting via conference call."

Retail Health Clinics

The meeting's agenda covered a wide range of topics, including retail health clinics. The meeting revealed that the Academy and CIGNA share similar concerns about the level of care that retail health clinics should provide to patients. The Academy shared its statement -- Desired Attributes for Retail Health Clinics -- with CIGNA and was pleased to hear that the insurer has no plans to give patients an incentive to use retail health clinics by offering copayments lower than what patients would pay their primary care physicians for office visits.

"CIGNA indicated that health care provided at retail health clinics may in fact cost more," said AAFP President-Elect Rick Kellerman, M.D., of Wichita, Kan.

Gelzer said CIGNA understands that retail health clinics are convenient for patients in some circumstances and acknowledged that employers like to offer their employees convenience. However, she stressed that such clinics should provide care for a "simple, discreet set of conditions" and that patients should see their primary care physicians for follow-up care. CIGNA "in no way, shape or form wants to interfere with the ongoing, longitudinal nature of the physician-patient relationship in a family physician's office," said Gelzer.

Personal Medical Home

The AAFP and CIGNA also agreed on the benefits of a personal medical home and about the ability of FPs to provide such a home.

"Certainly we agree with the AAFP in that we value the unique role of family physicians to provide improved coordination of medical care in a cost-effective manner, " said Gelzer. This is due in part to the ongoing relationship between the physician and the patient, as well as to "the medical home nature of the family physician practice," she said.

"CIGNA supports the concept that all Americans need a health care home," said Kellerman. "The medical home model is a win for all parties involved. Patients receive more comprehensive health care because family physicians are able to provide the continuity of care that enhances patient care. And it's cost effective for the payers."

The Academy, however, encouraged CIGNA to adopt a payment methodology that would more fairly compensate FPs for providing care management and coordination.

Performance Measures

During the meeting, CIGNA representatives noted that the company was one of the first health plans to press for the formation of the Ambulatory Care Quality Alliance, or AQA, a coalition of more than 125 organizations that has become a major player in the implementation of evidence-based performance measures.

"We commend the AAFP for their leadership in the AQA, and we are committed to working with the AAFP through AQA to implement mutually agreed-upon quality and efficiency measures to improve health outcomes and reduce disease burdens for our members," said Gelzer.

Kellerman said he hopes CIGNA will help lead the move to convince all payers to use AQA-approved quality measures. "It would be confusing and counterproductive for each payer to use different measures," he said.

Although CIGNA does not currently have a pay-for-performance program in place, Gelzer said the company would like to move to an outcomes-based payment system in the future.

Same-Day Preventive, Problem-Oriented Visit

The Academy also took the opportunity to reiterate its position that payers should pay physicians for both 'preventive and problem-oriented care services for patients when these services are delivered during a single office visit. Currently, CIGNA pays for only one of these services, based on whichever code is more extensive.

"The outcome of the discussion was positive because CIGNA is willing to reevaluate their current policy and is receptive to looking at different ways to approach payment," said Frank.

"We are willing to explore other options," confirmed Gelzer.

The meeting with CIGNA illustrates the Academy's ongoing effort to build strong working relationships with large national health plans. To date, representatives from UnitedHealthcare, Humana Inc. and CIGNA have, on separate occasions, visited Academy headquarters in Leawood, Kan. Aetna has accepted an invitation for a July meeting.