CIGNA Care Network^®

CIGNA Care Network is a benefit plan option available for CIGNA plans in 58 service areas across the country as of January 1, 2007. Developed in response to our customers' requests for more information about physician quality and cost efficiency, the CIGNA Care Network designation helps distinguish physicians within CIGNA's provider network based on their performance under specific quality and cost efficiency measures in 21 areas of specialty care.

Plan Description

Under the CIGNA Care Network benefit plan, a subset of participating physicians in 21 specialties is designated as CIGNA Care Network providers based on specific selection criteria. These specialties include allergy and immunology, gastroenterology, gynecology, orthopedics and surgery and dermatology. CIGNA participating providers are considered in-network whether or not they receive the CIGNA Care Network designation. However, a lower member copayment or coinsurance level applies if the member chooses a CIGNA Care Network designated physician.

Plan Availability

CIGNA Care Network will be available in the following service areas beginning January 1, 2007:

• Arkansas (Little Rock Metro)
• Arizona
• California (Los Angeles, Orange County, San Diego, Ventura, Bakersfield, Central California, Northern California, San Francisco and Sacramento)
• Colorado (Denver and Colorado Springs)
• Connecticut
• Delaware
• Florida (Orlando, Tampa, Ocala, South Florida and Jacksonville)
• Georgia
• Illinois (Chicago Metro, Champaign and Urbana)
• Indiana (except Evansville Metro)
• Massachusetts (Western Massachusetts)
• Maryland (Maryland and Washington, D.C.)
• Maine
• Nevada
• New Hampshire
• New York (Metropolitan New York)
• New Jersey (Northern and Southern New Jersey)
• North Carolina (markets vary)
• Ohio (Northern, Central and Southern Ohio)
• Oregon (Portland)
• Pennsylvania (Philadelphia, Pittsburgh, and Eastern and Western Pennsylvania)
• Rhode Island
• South Carolina (markets vary)
• Tennessee (Memphis, Nashville, Knoxville and rural Tennessee)
• Texas (Dallas, Ft. Worth and Houston)
• Utah
• Washington, D.C. (Maryland and Washington, D.C.)

Selection Criteria

CIGNA participating physicians in the 21 specialties listed below have been evaluated for CIGNA Care Network designation. Other CIGNA contracted providers, including primary care physicians, pediatric subspecialty physicians, hospital-based physicians, hospitals, ancillary providers and physicians in specialties not listed, are not CIGNA Care Network designated providers but are still considered participating providers for this plan option.

• Allergy/immunology
• Cardiology
• Cardio-thoracic surgery
• Colon and rectal surgery
• Dermatology
• Ear, nose and throat
• Endocrinology
• Gastroenterology
• General surgery
• Hematology/oncology
• Infectious disease
• Nephrology
• Neurology
• Neurosurgery
• Obstetrics/gynecology
• Ophthalmology
• Orthopedics and surgery
• Pulmonology
• Rheumatology
• Urology
• Vascular surgery

Participating specialists in the specialties listed above are evaluated annually for CIGNA Care Network designation. For 2007, participating specialists were evaluated based on the following criteria:

• Participating specialists who have been recognized by the National Committee for Quality Assurance (NCQA) for diabetes, heart/stroke care or physician practice connections automatically receive the CIGNA Care Network designation.
  
  
• Participating bariatric surgeons who perform surgery at one of the hospitals listed in the CIGNA Certified Hospitals for Bariatric Surgery directory and who met our selection criteria also receive the CIGNA Care Network designation.
  
  
• Participating specialists with sufficient patient volume and in certain specialties are evaluated under selected evidence-based quality measures that are derived from measures endorsed by the Ambulatory Care Quality Alliance (AQA), National Quality Forum (NQF) and Health Plan Employer Data and Information Set (HEDIS). Those who perform in approximately the top 25 percent of the market for these measures receive the CIGNA Care Network designation.

Participating specialists are also evaluated under other quality and efficiency measures. To be considered for the CIGNA Care Network designation under these measures, the participating specialist or group must have managed episodes of care for a minimum of 20 unique CIGNA HealthCare members over a two-year period. This helps to ensure statistical validity.

First, the specialist must meet our criteria for board certification and, if the specialist was evaluated under the evidence-based quality measures referenced above, the specialist's performance must exceed our minimum threshold for these measures.

Then, we evaluate the specialist's relative efficiency using the Episode Treatment Groups (ETG) methodology developed by Symmetry Health Data Systems, Inc. This methodology looks at medical costs (inpatient, outpatient, laboratory, radiology, pharmacy, etc.) for a given episode of care and profiles specialty care physicians against physicians in similar specialties. ETGs include case-mix adjustment to help account for differences in the severity of patients' illnesses and provide a consistent and reliable way to measure and compare costs.

Provider Reimbursement

The usual contracted rates for covered services provided to CIGNA members continue to apply regardless of a provider's CIGNA Care Network designation. However, members enrolled in a plan with the CIGNA Care Network benefit design have incentives to seek services from CIGNA Care Network designated physicians. These incentives may take the form of a lower copayment or coinsurance level.

Participating providers continue to see CIGNA members whose benefit plans do not include the CIGNA Care Network benefit design. For these members, the benefit incentive for CIGNA Care Network designated specialists described above does not apply.

Member Impact

Members enrolled in the CIGNA Care Network benefit plan option must see CIGNA Care Network designated specialists for those services to be covered at the enhanced benefit level. Members may still receive care from other CIGNA participating providers at the standard in-network benefit level.