Cigna Quality Improvement Program

Cigna Quality Improvement Program

Helping to improve the care we provide our customers and create a better quality of life.

The Cigna Quality Improvement Program uses surveys and preventive screenings to track and develop the health care we provide our customers. By comparing the results of our surveys and screenings, we’re able to see how our programs help your health.

Cigna’s Quality Improvement Program focuses on preventive screenings such as:

Breast Cancer

In 2018, Cigna aimed to have 84 percent of women complete a breast mammogram. Six markets saw at least 1 percent improvement in mammogram completion compared to 2017. One market surpassed that goal and reached 89 percent completion.

Colorectal Cancer

Cigna’s goal was for 81 percent of our customers to have a colorectal cancer screening in 2018. While 6 markets reached the goal, 9 markets improved in these screenings from 2017. Two markets decreased from the earlier year.

Diabetic Retinal Eye Exam

Our goal was for 81 percent of customers with diabetes to do the diabetic retinal eye exam. We saw improvements in 6 markets with increased diabetic eye exams. Eight markets reached the 81 percent goal.

High Blood Pressure

Blood pressure control scores improved in most markets in 2018. Two markets had improvement over 2017, with 1 reaching our goal of 85 percent of customers. This is measured by checking the health of each customer with high blood pressure, including but not limited to healthy diet, exercising, and taking prescribed blood pressure medications from their doctor.

In 2018, customer survey responses showed that we have made improvements overall. Our group will continue to focus on improvement in these areas:

  • Getting appointments with specialists
  • Keeping your doctor briefed about the care you get from specialists
  • Getting needed tests, care, or treatment
  • Making sure that your doctor talks about taking medicines with you
  • Getting seen within 15 minutes of appointment time
  • Giving you the facts you need when you call us
  • Addressing physical and mental health needs

Cigna Utilization Management associates base decisions on the clinical needs of members, benefit availability, and appropriateness of care. Objective, scientifically-based clinical criteria and treatment guidelines, such as InterQual measures, along with Medicare National Coverage Guidelines in the context of provider or member-supplied clinical information, lead the decision-making process. Cigna in no way rewards or incentivizes, either financially or otherwise, practitioners, utilization reviewers, case managers, physician advisers, or other individuals involved in conducting utilization review, for issuing denials of coverage or service, or inappropriately restricting care.

The Cigna Pharmacy and Therapeutics Committee and Clinical Guidelines Committee review new medications, medical and behavioral methods, and devices as potential benefit additions for our customers.

The Cigna Pharmacy and Therapeutics Committee is made up of practicing physicians and pharmacists from many clinical specialties, along with experts on care for older adults or disabled people. They consider whether a certain drug is better than, the same as, or worse than the medical benefit and safety of other drugs within the same drug class. They also look at scientific studies and standards of care, along with clinical guidelines, up to date medical and drug studies, and Food and Drug Administration approved uses of medications.

Based on this review, the Pharmacy and Therapeutics Committee votes on whether medications work better than, as well as, or worse than other treatments in terms of medical benefit and safety. This decision is used to help determine what drugs are listed on the formulary.

For residents of Tennessee, TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits.