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:

Annual Flu Vaccine

In 2020, Cigna’s goal was for 76% of our customers to get their annual flu vaccine. Four markets achieved this goal with 76% or more of customers getting their flu vaccine.

Breast Cancer

In 2020, Cigna aimed to have 69% of women complete a mammogram. Ten markets went above that goal and reached 77% completion.

Care for Older Adults: Medication Review and Pain Assessment

Cigna’s goal for older adult customers in 2020 to have their medications reviewed was 84%. Eight markets exceeded the goal for medication review with 93% medication reviews completed.

Cigna’s 2020 goal for pain assessment in older adults was 87%. Eight markets surpassed this goal with 95% of pain assessment completed.

Colorectal Cancer

Cigna’s goal was for 71% of our customers to have a colorectal cancer screening in 2020. All markets surpassed that goal and reached 78% completion.

Diabetic Retinal Eye Exam

In 2020, Cigna aspired to have 71% of customers with diabetes complete a diabetic retinal eye exam. Seven markets were successful in reaching that goal with a 72% completion rate.

Osteoporosis Management in Women who had a Fracture

Cigna sought a goal of 50% in 2020 for Osteoporosis Management in women who had a fracture. Two markets reached the goal of 50%.

Statin Therapy for Patients with Cardiovascular Disease

In 2020, Cigna’s goal was for 84% of our customers with cardiovascular disease to have statin therapy. Five markets met this goal with 84% of customers receiving statin therapy.

In 2021, your survey responses showed that we have made improvements overall. Our group will continue to focus on improvement in these areas:

  • Getting routine and urgent care appointments;
  • Getting seen within 15 minutes of appointment time;
  • Getting needed tests, care, or treatment;
  • Getting appointments with specialists;
  • Getting the help you need to manage your care;
  • Giving you the facts you need when you call us; and
  • 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.