Doctors Feel Pressure to Accept Risk-based Reimbursement

Jacqueline Fellows, for HealthLeaders Media , July 24, 2014

"Nationally, employers can't continue to incur double-digit increases in their second largest expense," says Lefkowitz. "By 2016, our goal is to move the majority of our contracts, particularly primary care contracts, to risk-based."

Healthcare Partners Nevada is one of Cigna's CAC partners. It was also one of the Medicare Pioneer ACOs, though now Lefkowitz says it's converted to a Medicare Shared Savings Program. The large, multi-specialty practice also has other value-based contracts with other payers. He says while the arrangements aim to reach have similar goals, the cost and quality metrics are not the same, and that can be a challenge for physicians.

"Nevada doesn't look like other CAC's (Cigna's model)," says Lefkowitz. "We have huge, self-funded clients, the casinos. The incentives are aligned for the patient, provider, and employer. For the first full year, we did slightly improve on quality, and we produced shared savings. We split a percentage of those savings with the employer group."

HealthCare Partners' achievement with Cigna mirrors the results the insurer found among its participants: 73% on average had 3% better than market average in total medical cost; 2% had better than market average in quality.

Lefkowitz says its cost savings were, in fact, much better than the 3%; he puts the savings closer to 18%.

Risk-based Arrangements Inevitable
Cigna's milestone of 100 CAC contracts is likely a notch in what is likely to become old news. More insurers are moving to risk-sharing arrangements, and they're being aggressive about strategy.

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