Rice U. study: Insurers and physicians can partner to deliver care more efficiently, save costs


David Ruth

Rice U. study: Insurers and physicians can partner to deliver care more efficiently, save costs

HOUSTON – (Sept. 8, 2016) – Insurers and physicians can partner to help physicians to deliver care more efficiently and save costs, according to a study by researchers at Rice University and Cigna, a global health service company.

artwork-for-ho-release-9-8The study’s findings are based on an examination of an arrangement Cigna made with a multiclinic physician practice in north Texas to improve quality of service and lower health care costs for patients covered through Cigna. The arrangement was part of Cigna’s Collaborative Accountable Care (CAC) initiative, which is a shared savings program that offers practices that are in their first year of participation an up-front care coordination fee to pay for investments in infrastructure that furthers progress toward quality and cost targets.

“There have been a growing number of studies trying to test whether coordinated care — think the Affordable Care Act’s Accountable Care Organizations — can restrain cost growth,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute for Public Policy and director of the institute’s Center for Health and Biosciences, who co-authored the study. “The results of other studies have been mixed. Our study may have been able to demonstrate a significant savings, because the financial agreement was forged directly with physicians, rather than mixed-provider organizations.

“Hospitals may have less incentive to restrain cost growth because so much of their revenue comes from providing inpatient care. In contrast, the share of physicians’ revenues associated with hospital care is much lower. With improved patient data provided by Cigna plus additional nursing support within the practice for follow-up, physicians can readily focus on delivering care quickly and efficiently,” Ho said.

The research findings are published in the American Journal of Managed Care.

In the study, Cigna provided a physician practice, Medical Clinic of North Texas (MCNT), with funds to invest in infrastructure, including informatics and care coordination. For example, Cigna funding helped MCNT to hire a nurse who could help with hospital discharge coordination for patients at increased risk of readmission, targeted outreach to high-risk patients, patient education and patients’ compliance with prescriptions. In addition, Cigna agreed to share with MCNT any realized cost savings from moving to a more coordinated care model.

This paper compares costs in 2009 before the intervention began to 2010 and 2011 when the intervention took effect. The sample size varied by year, but included 7,100+ MCNT patients and 180,000+ other patients in north Texas covered by Cigna in each year. The researchers found that costs for MCNT’s Cigna patients were lower by almost 6 percent relative to other patients covered by Cigna in the north Texas area. The savings occurred in multiple categories, including in procedures and testing. About half the savings was due to lower use of services, while the rest was due to reductions in price.

The researchers did not quantify the improvement in quality of care associated with this contract. “However, MCNT did meet the quality requirements specified in the contract, so we know that service quality did not decline,” Ho said.

“Measuring the Cost Implications of the Collaborative Accountable Care Initiative in Texas” was also co-authored by Meei-Hsiang Ku-Goto, research programmer at the Baker Institute; current Cigna employees Tim Allen, William Keenan and Urie Kim; and former Cigna employee Mark Sanderson. Ho is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine.

Drs. Ho, Ms. Ku-Goto, and the Baker Institute did not receive funding from Cigna.


Related materials:

The study can be found at http://www.ajmc.com/journals/issue/2016/2016-vol22-n9/Measuring-the-Cost-Implications-of-the-Collaborative-Accountable-Care-Initiative-in-Texas

Ho bio: http://bakerinstitute.org/experts/vivian-ho.

Follow the Baker Institute via Twitter @BakerInstitute.

Follow the Center for Health and Biosciences via Twitter @BakerCHB.

Follow Rice News and Media Relations via Twitter @RiceUNews.

Founded in 1993, Rice University’s Baker Institute ranks among the top five university-affiliated think tanks in the world. As a premier nonpartisan think tank, the institute conducts research on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy. The institute’s strong track record of achievement reflects the work of its endowed fellows, Rice University faculty scholars and staff, coupled with its outreach to the Rice student body through fellow-taught classes — including a public policy course — and student leadership and internship programs. Learn more about the institute at www.bakerinstitute.org or on the institute’s blog, http://blogs.chron.com/bakerblog.

Located on a 300-acre forested campus in Houston, Rice University is consistently ranked among the nation’s top 20 universities by U.S. News & World Report. Rice has highly respected schools of Architecture, Business, Continuing Studies, Engineering, Humanities, Music, Natural Sciences and Social Sciences and is home to the Baker Institute for Public Policy. With 3,910 undergraduates and 2,809 graduate students, Rice’s undergraduate student-to-faculty ratio is 6-to-1. Its residential college system builds close-knit communities and lifelong friendships, just one reason why Rice is ranked No. 1 for best quality of life and for lots of race/class interaction by the Princeton Review. Rice is also rated as a best value among private universities by Kiplinger’s Personal Finance. To read “What they’re saying about Rice,” go to http://tinyurl.com/RiceUniversityoverview.

About David Ruth

David Ruth is director of national media relations in Rice University's Office of Public Affairs.