For security reasons, Cigna.com no longer supports your browser version. Please update your browser, or use an alternative browser such as Google Chrome, Microsoft Edge, or Mozilla Firefox for the best Cigna.com experience.
Focusing on Affordability, Predictability, and Simplicity
We are redefining the future of health care to move towards 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, we are focused on treating the body and mind as one to help people live their healthiest, most productive, and most vital lives. Towards that aim, 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.
Clinical Quality Accreditations and Programs
Cigna continues to demonstrate a commitment to quality, by which we mean providing customers with the right care at the right time in the right place. 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 Governing Body (QMGB), 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.
The QMGB is given the authority by the Chief Clinical Officer, to oversee the Quality Programs for Cigna Corporation operating subsidiaries. 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. Cigna uses the Healthcare Effectiveness Data Information Sets (HEDIS®)1 to evaluate performance and identify opportunities for improvement using a market-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 National Association of Committee for Quality Assurance (NCQA)-auditors, who certify data reliability and integrity and evaluate the effectiveness of managed care clinical programs.
In 2020, Cigna earned and maintained 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 for seven Onsite Health clinics
Cigna's Pharmacy Benefit Management program holds accreditation with the National Association of Boards of Pharmacy (NABP) Digital Pharmacy (formally known as Verified Internet Pharmacy Practice Site [VIPPS] and the Pharmacy Verified Websites Program.
Additionally, Cigna's Health Services businesses earned and/or maintained the following accreditations for Cigna's utilization management, case management and pharmacy programs in 2020:
- NCQA Certification for Utilization Management (Express Scripts, eviCore Healthcare/CareCore National, CareContinuum);
- URAC Health Utilization Management (CareContinuum, eviCore Healthcare)
- URAC Health Case Management
- URAC Pharmacy Benefit Management (Express Scripts)
- CMS Certification of On-Exchange Markets
- URAC Specialty Pharmacy (Accredo, Freedom Fertility)
- URAC Mail Service Pharmacy (Express Scripts Pharmacy)
- The Joint Commission (TJC) Home Care Accreditation: Specialty Pharmacy, Home Infusion Therapy (HIT) Provider, Home Health Skilled Nursing, Ambulatory Infusion Suites, Durable Medical Equipment (Accredo)
- National Association of Boards of Pharmacy (NABP) Digital Pharmacy (formally known as Verified Internet Pharmacy Practice Site [VIPPS] (Accredo, Express Scripts)
- NABP Pharmacy Verified Websites Program (Express Scripts, Accredo, Freedom Fertility, Inside Rx)
- LegitScript Healthcare Merchant Certification (Inside Rx)
- NABP Drug Distributor Accreditation (formerly known as Verified Accredited Wholesale Distributors [VAWD]
Other Awards and Recognitions
Cigna was recently recognized by the National Alliance of Healthcare Purchaser Coalitions (NAHPC) with the 2019 and 2020 eValue8 Innovation Award for our pharmacy integrated health benefits program, which has resulted in increased health engagement and savings, and for our Breast Cancer Screening Disparity Initiative in Tennessee. Similarly, in the latest scored eValue8 (2018) Cigna’s Connecticut PPO plan is the national benchmark of PPO plans in eValue8.
Additionally, Cigna’s newest social determinants of health (SDoH)2 initiative, is a distress screening tool for cancer patients, was selected by NCQA for submission in their 2020 SDoH resource publication.
Partnering with Providers to Deliver a Value-Based Care Model
The Cigna Collaborative Care® program includes accountable care organizations (ACOs) and is Cigna's approach to achieving population health goals. 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. Unlike other programs, our ACOs are embedded in our networks.
Cigna launched its value-based care delivery more than ten years ago. Through coordinated, value-based care, ACOs provide better results, improve affordability and efficiency, and deliver a better experience for patients.
Value-based care programs encompass over 700 accountable care programs including more than 230 ACOs. Through our arrangements, we contract with over 99,000 primary care providers, and over 78,000 specialist programs. As a result of our focus, in 2020 the 2.9 million customers in value-based care arrangements received quality care in a timely manner.
In 2020, due to the COVID-19 pandemic, we pivoted from growing our collaborative care arrangements to focusing on working with our existing collaborative partners to help ensure that our customers received comprehensive care. COVID-19 resulted in deferred and delayed preventive and chronic illness care as well as increased levels of depression, both of which exacerbated health care disparities. To combat these trends, we focused our value-based partnerships on addressing these interconnected issues.
Cigna began providing bundled payments for maternity programs in the United States in 2015. Over the past five years we have expanded the number of providers that we work with and now partner with approximately 50 in 20 states plus Washington, D.C., including the U.S. Women’s Health Alliance. Results from maternity program 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. Our collaborative efforts with the U.S. Women’s Health Alliance alone resulted in savings of over $4.5 million in one year.
Through 2019, in our priority markets, a total of approximately 46 percent of total spend goes through Accountable Care programs with approximately 17 percent of value-based spend tied to Hospital Collaboration Care programs.
We offer tailored, integrated benefits combining medical, pharmacy, and behavioral care to approach each individual as a whole person and drive better health outcomes. Benefits of such integration include:
- Identifying behavioral risks earlier through connectivity and predictive modeling.
- Health coaching, case management specialists, and expanded behavioral health offerings.
- Connected care via our Cigna Collaborative Care® programs.
Our annual externally validated Value of Integration study shows that clients with integrated medical, pharmacy, and full behavioral health benefits see greater savings in total medical costs compared to those with medical and basic behavioral health.
On average, in 2020, those with fully integrated benefits:
- Saw annual medical cost savings of approximately $6,400 for individuals with conditions requiring a specialty medication.
- Saved approximately $6,700 for customers with an oncology diagnosis, and approximately 12 percent lower inpatient readmissions.
With connected benefits, customers are more engaged in their health and well-being, are more likely to stay in-network for their care, and are more informed about their care options, which helps drive down costs and often translates to improved outcomes.
The 2020 study showed3, on average:
- 25 percent higher customer engagement in medical case management and behavioral coaching.
- 6 percent less use of an emergency room and 7 percent more likely to use highest-performing providers.
- 21 percent higher engagement rate in health improvement opportunities and 16 percent lower inpatient admissions for those with a depression diagnosis.
In 2020, customers with fully integrated health benefits saved approximately $200 annually and customers with fully integrated health benefits and a health improvement opportunity saved approximately $4,700 annually.
11HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
2Social determinants of health are the economic and social conditions that influence individual and population differences in health status.
3New Cigna Study Shows Integrated Medical, Pharmacy and Behavioral Benefit Design Delivers Better Health Outcomes and Improves Affordability. Cigna, January 12, 2021. Cigna Newsroom | New Cigna Study Shows Integrated Medical, Pharmacy and Behavioral Benefit Design Delivers Better Health Outcomes and Improves Affordability.