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Opioids and Mental Health

Making Real Progress to Tackle the Opioid Crisis

Cigna is committed to being a national leader in addressing the opioid crisis. We have partnered with over 1 million prescribing physicians and, in 2018, achieved our bold goal of reducing opioid use among our customers by 25%, one year ahead of schedule.

We targeted 25% because this reduction would return customers’ usage of opioids to pre-epidemic levels. To track against our progress against this goal, we measured the total volume of opioids being prescribed based on morphine milligram equivalent doses, taking into account the number of pills, the dosing of those pills, as well as the relative strengths of the different opioid medications.

Cigna collaborated with physicians, dentists, patient awareness and support organizations in local communities to identify immediate and longer-term approaches that increased safeguards in the opioid prescribing process, enhanced support and counseling, and made it easier to access treatments for substance use disorders.

We convened more than 2,000 medical groups representing more than 65,000 doctors in a focused effort to reduce opioid prescribing and to treat opioid use disorder as a chronic condition, one patient at a time. We also engaged with more than 85,000 prescribers annually whose patients have a concerning pattern of opioid prescription use to ensure that prescriptions are appropriate, medically necessary and safe for the patient.

Additionally, we convened local leaders to better understand the impact of the epidemic in communities like New York, Houston and Los Angeles and identify solutions together that create greater awareness, more innovative treatments, and prevention. We also opened Cigna’s 24/7/365 free counseling helplines to all veterans and their caregivers, whether they are Cigna customers or not, to help this community which is particularly vulnerable in this national epidemic.

Where Do We Go From Here

Despite this reduction in overall opioid use, opioid overdoses continue to rise. In 2018, we set a new goal to reduce customer overdoses in targeted communities by 25% by the end of 2021. 

To meet this goal, our initial focus is on targeted U.S. communities where a sizable number of Cigna customers reside and where there are higher incidences of overdose. These communities include: Connecticut, Maryland, New Jersey, Virginia, Chicago, New York City, Philadelphia, Washington, D.C. 

We are also leveraging our predictive analytics capabilities to identify patients who are more likely to suffer from an overdose and prompts interventions to help prevent the overdose from happening. These efforts are targeted in key regions of the country that have been hit particularly hard by opioid overdoses. 

We are committed to helping customers and their families when and where they need us and are dedicated to guiding doctors and customers to improved care for chronic pain and substance use disorder; improving outreach to at-risk customers and their providers; improving access to effective addiction treatment; engaging the community to prevent addiction, increase access and use of treatment; preventing new customers from being at high risk; improving physician prescribing behaviors; improving access to effective, comprehensive chronic pain management and aligning incentives across the delivery system to provide optimal care.

Removing Stigmas and Creating Necessary Dialogue on Mental Health

Cigna has a history of being an early leader in viewing physical health and mental health holistically. We have strengthened our commitment to whole person health through our evolved mission to improve the health, well-being and peace of mind of those we serve.  Including ‘peace of mind’ in our mission provides a bold aspiration that is strongly aligned to whole person health with deeper recognition of the connection of the body and mind –understanding its central importance to all of our customers and patients around the world, and across our business segments. 

We remain dedicated to removing the negative stigma of mental health by being a champion of whole person health and well-being. In 2018, we launched a strategic initiative, bringing together three cultural icons in a campaign, Queen Latifah, Nick Jonas and Ted Danson, to help remove the stigmas of mental health to encourage everyone to schedule their annual check-up and talk openly and honestly with their health care providers about how they are feeling, physically and emotionally. The mind and body are connected and we are encouraging [customers/people] experiencing stress, anxiety, depression or substance use disorders to connect with their doctor so their physical well-being does not suffer as well. 

The campaign initiative builds upon Cigna’s preventive care efforts encouraging people everywhere to Go. Know. Take Control ® by going to see their health care provider for an annual check-up, knowing their four health numbers (blood pressure, cholesterol, blood sugar and body mass index) and taking control of their health. With this initiative, Cigna is again calling on people to seek preventative care, but also to make the time they spend with their health care provider even more impactful by having an open discussion about both their physical and emotional health. 

In 2019, the Cigna Total Behavioral Health® has expanded our comprehensive suite of behavioral health offerings. We are collaborating with mental health and well-being technology companies Happify Health and Prevail Health. Cigna will add the companies’ respective evidence-based digital platforms to help customers build greater resilience, as well as cope with stress, anxiety and depression. These digital platforms deliver convenient and personalized online support for mental well-being. At Cigna, the customer is at the center of everything we do. We will continue to look for opportunities to support the whole person in meaningful ways.

Talking About Loneliness and its Root Causes

Loneliness is a rising public health problem in the United States1 . Research shows that chronic loneliness leads to poorer health outcomes2 . It has been correlated with increased risks for diabetes3 , heart disease4 , depression5 , suicide, substance use disorders, and even dementia. It is as deadly as smoking 15 cigarettes a day6 . Improving people’s sense of connection to others will improve their overall health and functioning. Together we can start a dialogue around proactive steps that individuals, communities, and employers can take to tackle it. In 2018, Cigna released results from a groundbreaking national survey exploring the impact and the potential underlining root causes of loneliness in the United States. The survey of more than 20,000 U.S. adults ages 18 and over, conducted in partnership with market research firm Ipsos, revealed that most American adults are considered lonely, and that the youngest generation of adults is the loneliest of all.

The survey also revealed several important bright spots. The findings reinforce the social nature of humans and the importance of having communities. People who are less lonely are more likely to have regular, meaningful, in-person interactions; are in good overall physical and mental health; have achieved balance in daily activities; and are employed and have good relationships with their coworkers. More specifically, the survey showed people who engage in frequent meaningful in-person interactions have much lower loneliness scores and report better health than those who rarely interact with others face-to-face.

Providing Mental Health Resources to Customers

Cigna has several programs in place to help address loneliness:

  • The company’s Health Information LineSM is always available, so customers can speak with a clinician directly to get advice on confidential physical and mental health issues or listen to pre-recorded audio on a wide range of health topics.
  • Cigna’s Employee Assistance Program (EAP) provides customers with live telephone advice and practical solutions on a wide range of issues that can cause stress and isolation, including parenting and childcare, senior care, pet care, identity theft, legal and financial advice, and much more. Cigna’s EAP also provides referrals to licensed behavioral health professionals to improve customers’ mental wellness.
  • Cigna’s CLIMB (Changing Lives by Integrating Mind and Body) is a program for customers taught in groups or one-on-one that is designed to help people manage chronic health issues that affect their day-to-day functioning and improve quality of life. The program also helps reduce the isolation that often comes with chronic health conditions.

Case Study: Cigna's Education Campaign on Managing Pain without Opioids

In 2018, Cigna launched the next chapter in its work to reduce opioid addiction by encouraging a dialogue among stakeholders before an opioid prescription is written.
Read More

1 Loneliness in the Workplace Can Be a High Cost For Employers, American Psychiatric Association (APA) Center for Workplace Mental Health, 2018; http://workplacementalhealth.org/News-Events/Blog/January-2018/Loneliness-in-the-Workplace-Can-Be-a-High-Cost

2 Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

3 Socially Isolated Individuals are More Prone to Have Newly Diagnosed and Prevalent Type 2 Diabetes Mellitus – the Maastricht Study, BMC Public Health, 2017; https://bmcpublichealth.biomedcentral.com/articles/%2010.1186/s12889-017-4948-6

4 Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-Analysis of Longitudinal Observational Studies, BMJ Journals Heart, 2016; http://heart.bmj.com/content/102/13/1009.info

5 Unraveling the Role of Loneliness in Depression: The Relationship Between Daily Life Experience and Behavior, Interpersonal and Biological Processes, 2017; https://www.tandfonline.com/doi/full/10.1080/00332747.2016.1256143

6 Testimony before the US Senate Aging Committee, Julianne Holt-Lunstad, Ph.D., 2017; https://www.aging.senate.gov/imo/media/doc/SCA_Holt_04_27_17.pdf

Disclaimer: The report covers calendar year 2018 and unless otherwise noted, excludes the combination with Express Scripts, which closed on December 20, 2018.