Statistics show that U.S. residents receive appropriate medical care
only about 55 percent of the time*. This means a significant number
of individuals may not be receiving care that is consistent with evidence-based
medical guidelines. This not only compromises care, but can also result
in missed opportunities for managing a chronic condition or treating
symptoms before they become acute - ultimately leading to the need
for more costly treatment. The result is more severe illnesses
and increased costs for both individuals and their employers.
The CIGNA Well Informed program addresses this cost and quality issue
by identifying possible gaps or omissions in care, proactively alerting
members and their physicians, and suggesting steps to close these potential
gaps.
Every month, CIGNA analyzes members’ integrated medical, pharmacy,
behavioral and lab data to identify possible gaps in care using rule-based
software. Well Informed then communicates this information to
physicians, so they can either reach out to their patients or discuss
this information at the patient’s next visit. Simple, easy-to-understand
information is also sent to members, to help them understand potential
gaps, improve adherence to existing therapies and prompt discussions
with their physicians. The same information is shared with the
clinical staff of our health advocacy programs, including case management,
disease management, Health Advisor, pharmacy outreach and CIGNA Behavioral
Health. This integrated approach helps ensure that outreach to members
is coordinated, and that all parties are informed of potential issues
and how they might address them.
Well Informed letters are personalized with specific information about
any potential gaps the particular member may have, the data that led
us to identify the gap, why addressing the gap could be important,
what steps the member can take, and how to get more information.
CIGNA HealthCare believes strongly that identification and resolution
of gaps in care is critical to improving the health and well-being
of our members. So we will provide all Well Informed features and services
as core components of all CIGNA plans at no additional charge. The
Well Informed program will be piloted in the second half of 2007 with
select physicians and members; the program is targeted to be available
to all CIGNA customers at the beginning of 2008.
Well Informed, Information for Bridging Gaps in Care.
* New England Journal of Medicine, March 16, 2006
