Focusing on Affordability, Predictability, and Simplicity
We are redefining the future of health care to create a system of “well care.” A system that champions healthy living and proactive, preventive care, and surrounds each individual with supportive tools and resources to minimize the chance of illness and disease. As we enhance delivery of whole person health – treating the body and mind as one to help people live their healthiest, most productive, and most vital lives – Cigna is addressing the need for greater affordability, predictability, and simplicity.
These strategic imperatives are central to our brand promise and how we engage and interact with customers:
- Affordability means helping customers find the right care, at the right price. We are committed to delivering sustainable medical and pharmacy costs for our customers – and as a larger, integrated company, we have the ability to deliver on that promise. Affordability also drives us to encourage, support, and incentivize health – for individuals and health care providers. The integration of behavioral health care as part of whole person health is also an important tool to lower costs. To further improve customer health and affordability, Cigna launched several initiatives involving new and improved solutions and benefits in 2019. For example, Cigna introduced benefits for its Medicare Advantage Customers in select plans to address Social Determinants of Health (SDoH),1 including:
- Air conditioner allowance in some Texas plans;
- Fall prevention program in some Mississippi and Kansas plans;
- Adult day care allowance in New Jersey plans;
- Acupuncture allowance for all Preferred Provider Organization (PPO) plans and Colorado Health Maintenance Organizations (HMO) plans; and
- Expanded transportation benefits – including trips to places of worship and grocery stores – in some Arizona and Pennsylvania plans.
- Predictability means guiding customers to high-performing care. It also means innovative programs and tools, such as the Patient Assurance Program for diabetic insulin and Embarc Benefit Protection for gene therapy. The former, launched in 2019, creates cost predictability for customers managing their diabetes. This program ensures that eligible customers with diabetes in participating plans pay no more than $25 for a 30-day supply of insulin.2 Predictive analytics-driven solutions also create predictability for customers, because they allow Cigna to proactively identify and address risk.
- Simplicity means a more integrated and personalized health care experience; tools and resources that promote connectivity and engagement; and tailored networks of hospitals, pharmacies, and providers.
Cigna’s integration with Express Scripts has furthered our creation of a blueprint for personalized, whole person health care: enhancing our ability to put the customer at the center of all that we do. Together, our data-driven insights, combined with our clinical expertise, have enabled us to create uniquely tailored interventions that have more frequently delivered the right amount of medicine to the right customer at the right time. Our differentiated solutions address both utilization and cost, positioning us to deliver health outcomes that our competitors cannot. Cigna also strategically focuses on offering customers choice, to make it easier for them to access the health services that they need.
Partnering with Providers to Deliver a Value-Based Care Model
Cigna Collaborative Care® is Cigna’s approach to achieving the same population health goals as accountable care organizations (ACOs). Cigna has been a leader in creating ACO programs for more than 10 years. Through coordinated, value-based care, ACOs provide better results, improve affordability, and deliver a better experience for patients and health care providers.
These programs encompass more than 3.6 million customers with access to value-based care through over 240 primary care provider organizations, over 500 hospital facilities, and more than 250 specialist programs in six disciplines, including over 245 Episodes of Care programs. Today, 96% of Cigna customers in our top 40 markets are within 15 miles of at least three participating primary care providers. Additionally, we are delivering on our health care promise by establishing goals to reach 280 collaborative care arrangements with primary care organizations, growing to over 600 hospital facilities with reimbursements tied to quality metrics, and reaching approximately 380 specialist groups in value-based reimbursement arrangements by the end of 2020.
ACOs incentivize providers to help patients stay healthy and get healthy by basing provider payments on health outcomes and quality metrics instead of the volume of care and services accessed. Our support of ACOs is predicated on our belief that in order for health care systems to become more sustainable, they must adopt a business model that focuses on positive outcomes instead of relying on a fee-for-service model.
In 2015, Cigna introduced bundled payments for maternity programs in the United States U.S. We currently work with 49 providers in 22 states, including the U.S. Women’s Health Alliance. Results from OB/GYN providers in the program for three or more years illustrate the benefits of focusing on health outcomes instead of the volume of care and services accessed. These providers reduced costs by at least 5% each year; performed 7% better than projected at reducing C-sections; and increased gestational diabetes screening completion rates among patients by 39%.
1 in 5 Cigna customers visited an ACO provider in 2019, resulting in a 22% increase in customer engagement and an 8% increase in preventive care visits.
We connect care across medical, behavioral, and pharmacy services, which allows us to approach care delivery to each patient as a whole person. This includes:
- Delivery of connected care through ACO programs;
- Reimbursement of primary care providers (PCPs) for behavioral services;
- Access to specialty pharmacy drugs managed by Accredo, which connects patients to other services, including behavioral health care;
- Integrated electronic medical records; and
- Choice for customers around how and when they want to access care:
- 24/7 support, including access to behavioral specialists, crisis support, and nurses;
- Expanded access to health care providers through our growing network, as well as access to virtual options; and
- Employee Assistance Program (EAP) access for customers and anyone who shares their address.
In 2019, Cigna produced an externally validated report on the value of integrated benefits, which showed that connected benefits customers are more engaged in their health and well-being; more likely to stay in-network for their care; and more informed about their care options – all of which not only drive down costs, but often translate to improved outcomes. The study showed,3 on average:
- 17% higher customer engagement in programs, such as counseling for conditions like diabetes and heart disease; lifestyle or wellness coaching to help with weight management and smoking cessation; and personal case management for more complex conditions such as rheumatoid arthritis and cancer.
- 32% lower mental health readmission rates and 18% fewer out-of-network behavioral claims.
- 5% higher utilization of in-network and high-performing providers, which translated into 4% lower out-of-network claims.
- Improved outcomes for individuals in need of treatment for opioid misuse – with a 15% higher rate of receiving treatment and 30% reduction in subsequent overdoses when an overdose was experienced one year prior.
In 2019, customers with fully integrated health benefits saved $207 annually and customers with fully integrated health benefits and a health improvement opportunity saved $867 annually.
Clinical Quality Accreditations and Programs
Cigna continues to demonstrate a commitment to quality. We have invested substantial resources in a broad scope of Quality Programs, validated through nationally recognized external accreditation organizations and through numerous awards.
We have an integrated Quality Management Committee, which is responsible for annually evaluating the performance of Quality Programs; monitoring a wide range of quality indicators and activities that ensure quality of care and quality of service to our customers; and driving improvement throughout the organization. Quality oversight is performed by the Chief Medical Officer, who has designated the Quality Management Governing Body to oversee enterprise-wide quality activities.
While the Quality Program is administered by a National Quality team, the responsibility for maintaining a robust and successful Quality Program extends beyond the National Quality team and includes collaboration and support from multiple operational areas across the enterprise.
In 2019, Cigna earned and maintained National Committee for Quality Assurance (NCQA) accreditation, certification, or recognition of the following:
- Health Plan Accreditation
- Managed Behavioral Healthcare Organization Accreditation
- Wellness and Health Promotion Accreditation
- Disease Management Accreditation
- Physician and Hospital Quality Certification
- Patient-Centered Connected Care Recognition
Additionally, Cigna's Utilization Management, Case Management, and Pharmacy Benefit Management programs hold Utilization Review Accreditation Commission (URAC) accreditations.
Health Services subsidiaries earned and maintain the following accreditations;
- NCQA for Utilization Management;
- URAC Health Utilization Management;
- URAC Pharmacy Benefit Management;
- URAC Specialty Pharmacy and URAC Mail Service Pharmacy;
- The Joint Commission (TJC) Home Care accreditation;
- National Association of Boards of Pharmacy (NABP) Verified Internet Pharmacy Practice Site (VIPPS);
- NABP Dot Pharmacy Verified Websites Program; and
- NABP Drug Distributor Accreditation (formerly known as VAWD).
Cigna was recently recognized by the National Alliance of Healthcare Purchaser Coalitions (NAHPC) with its 2019 eValue8 Innovation Award for its pharmacy integrated health benefits program, which has resulted in increased health engagement and savings. Similarly, Cigna's Connecticut PPO plan is the national benchmark of PPO plans in eValue8. Additionally, Cigna’s newest SDoH initiative is a distress screening tool for cancer patients and Cigna’s SDoH initiative to prevent social isolation has been selected by NCQA for submission in their upcoming 2020 SDoH resource publication.
Cigna uses the Healthcare Effectiveness Data Information Sets (HEDIS®)4 to evaluate performance and identify opportunities for improvement using a marker-based approach. HEDIS is one of the most widely used performance improvement tools in health care and is a standardized set of measurements for health plans that undergoes strict validation by NCQA auditors, who certify data reliability and integrity and evaluate the effectiveness of managed care clinical programs.
1Social determinants of health are the economic and social conditions that influence individual and population differences in health status.
2The Patient Assurance Program is available to customers in participating non-government funded pharmacy plans managed by Express Scripts, including Cigna and many other health plans with out-of-pocket costs for insulin greater than $25 (out-of-pocket costs for insulin include deductibles, copays, and coinsurance).
3“Combining Medical, Pharmacy and Behavioral Benefits Delivers Annual Savings of More than $850 per Customer with an Identified Health Improvement Opportunity.” Cigna, a Global Health Insurance and Health Service Company. Cigna, January 6, 2020. https://www.cigna.com/newsroom/news-releases/2020/combining-medical-pharmacy-and-behavioral-benefits-delivers-annual-savings-of-more-than-850-percustomer-with-an-identified-opportunity.
4HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).