Focusing on Affordability and Personalization
As we enhance delivery of whole person health, Cigna is proactively addressing the need for greater affordability, choice, and predictability by leveraging a significantly stronger medical and pharmacy cost position, as well as more actionable insights and analytics with enhanced clinical and care coordination capabilities.
Our strategic imperatives of affordability and personalization 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. Affordability also drives us to help customers get the most value from their benefit plans–and to help them lower their costs as their health improves. One important way we do this is through maximizing the relationship between our customers and health care professionals to ensure customers get quality, cost-effective care.
- Personalization means we develop personalized solutions that aim to fit the needs of individuals based on their specific situations and health and wellness needs.
Through our combination with Express Scripts, which closed at the end of 2018, we are establishing a blueprint for personalized, whole person health care, further enhancing our ability to put the customer at the center of all we do by creating a flexible, open, and connected model that improves affordability, choice, and predictability. Together, our data-driven insights, combined with our clinical expertise, enable us to create uniquely tailored interventions that more frequently deliver 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 others cannot. Cigna strategically focuses on offering customers choice, to make it easier to access the health services they need.
Transforming Towards a Value-Based Care Model
Since 2008, Cigna has been at the forefront of the accountable care organization movement supporting groups of doctors, hospitals, and other health care providers coming together to offer high-quality coordinated care to patients. Through our partners with accountable care organizations, health care is paid for based on outcomes and not services provided. In 2015, Cigna established a goal to accelerate the transition to alternative payments models that link health care provider payments–connecting quality and affordability. In 2018, Cigna exceeded the goal of having 50 percent of payments to health care professionals made through alternative payment arrangements, moving away from fee-for-service models in our top 40 markets. Additionally, 85% of Cigna Medicare Advantage customers access care through value-based arrangements.
Our transition away from the fee-for-service model has resulted in more than $600 million in medical costs savings since 2012.
Partnering With Physicians on Affordability, Access, and Experience
Physicians have a significant level of influence and a high level of trust with patients. By optimizing the patient/physician relationship with clinical, financial, and incentive programs along with data, analytics, and health engagement tools, Cigna is able to connect care between our customers and health care professionals in faster, smarter, and easier ways. Our physician partnership capability drives our successful Cigna Collaborative Care efforts where we work with health care professionals across the care delivery spectrum, including large and small physician groups, specialist groups, and hospitals to achieve better health outcomes to greater affordability and better experiences for our clients and customers.
These programs encompass more than 3.6 million commercial customers with access to value-based care through over 240 primary care provider organizations, over 500 hospital facilities, and over 250 specialist programs in 6 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 3 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.
In 2018, Cigna supported collaborative clinical initiatives that reached over 55,000 customers.
Clinical Quality Accreditations and Programs
We continue to demonstrate our commitment to quality and have a broad scope of quality programs validated through nationally recognized external accreditation organizations. We achieved Health Plan accreditation from the National Committee for Quality Assurance (NCQA) in all locations where accreditation is available, which is currently in 38 states. Additional NCQA recognitions include full accreditation for Managed Behavioral Healthcare Organization for Cigna Behavioral Health; accreditation with Performance Reporting for Wellness & Health Promotion; accreditation for our Disease Management programs and Physician & Hospital Quality Certification for our provider transparency program.
Additionally, we have full accreditation for Health Utilization Management, Case Management, Pharmacy Benefit Management, and Specialty Pharmacy from URAC, an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification, and commendation.
Cigna uses the Healthcare Effectiveness Data Information Sets (HEDIS) to evaluate performance and identify opportunities for improvement using a marker-based approach. HEDIS is a standardized set of measurements for health plans that undergoes strict validation by NCQA certified auditors to certify data reliability, integrity, and evaluate the effectiveness of managed care clinical programs.
Disclaimer: The report covers calendar year 2018 and unless otherwise noted, excludes the combination with Express Scripts, which closed on December 20, 2018.