Brown & Toland and Cigna: A PPO Case Study

In late 2013 and early 2014, Brown & Toland launched new Anthem Blue Cross and Blue Shield PPO Accountable Care Organizations (ACOs), bringing our total number of ACO programs to six. Here we profile results from our Cigna PPO ACO, which we launched in 2012.

Brown & Toland’s partnership with Cigna on this collaborative care initiative made significant progress in 2014 toward achieving its three key objectives: improved patient health, increased affordability, and a better overall patient experience.

Over the course of the program, participating Brown & Toland doctors have delivered efficient, cost-effective, quality care to more than 12,000 Cigna customers across the Bay Area. Critical to the program’s success are Brown & Toland’s clinical care coordinators—including nurses, doctors, and other professionals—who help patients with chronic conditions or other health challenges navigate the healthcare system. The care coordinators enhance care by using customer-specific data from Brown & Toland and Cigna to identify individuals discharged from the hospital who might be at risk for readmission, as well as assist patients who may be overdue for important health screenings or who may have skipped a prescription refill. Patients also receive health education and have access to both organizations’ wellness and clinical programs.

The ACO’s outpatient success is a result of Brown & Toland’s strong partnerships with ancillary facilities, as well as our doctors’ commitment to decreasing avoidable emergency room visits by providing easy access to primary care services. Patients in the inpatient setting have the benefit of working directly with Brown & Toland’s nurse care managers and care coordinators to make sure they receive the support they need, both in the hospital and after discharge.

The Results 

Inpatient Costs                          Outpatient Costs                         Medical Cost Trend

- 3%                                            - 6%                                            -5.4 percent (from local market)