Key Findings from the 2013 Quality and Utilization Management Program

In 2013, Cigna achieved several significant clinical and service improvements for customers and for professionals in our treatment networks, including

Improvements for Members

• Antidepressant Medication Management: As a result of prescriber and customer outreach, Cigna supported customer understanding of depression and the importance of medication compliance. These interventions resulted in improved rates for individuals prescribed antidepressant medications that remain on those medications for both 12 weeks and 6 months following the initial prescription.
• Medication Adherence for Bipolar Disorder: Rates were significantly improved for individuals taking medication as prescribed for Bipolar Disorder, as a result of Cigna’s coaching and case management program for customers combined with prompts to prescribers when customer rates for medication refill adherence fell below 80%.
• Telephone Abandonment Rate: Rates for abandoned calls were reduced significantly as a result of Cigna's improved responsiveness and more efficient telephone workflows.
• Member satisfaction: Significantly higher satisfaction for access to routine behavioral care appointments and for the helpfulness of Cigna's behavioral Personal Advocates department resulted from an increased focus on improving the customer experience. Further, customer experience surveys achieved significant improvements in ratings for complaints, appeals, and for claims satisfaction.

Improvements for Professionals in the Treatment Network

• Claims Turnaround Times and Appeal letter compliance: These important rates of success improved significantly as a result of increased monitoring and workflow improvements.
• Practitioner Satisfaction: multiple initiatives resulted in significantly improved professional satisfaction with Cigna's Provider Relations Representatives. Survey responses measured improvements for Cigna's ability to address concerns, keeping the professional’s practice up-to-date on important changes, the timeliness of Communication and Information, overall Communication and Information, website improvements for health care professionals, more efficient telephone contact to request benefit, eligibility, and claims information, and for the accuracy and timeliness of claims processing.
• Network Growth: Significant growth in the national network of contracted professionals was achieved in 2013. The number of contracted professionals grew for every discipline, resulting in a nearly 6% growth rate for the network overall. Additionally, Crisis Stabilization response capability was expanded by nearly 12%.

Other Accomplishments

• Improved ability to respond to state regulatory requirements, driven by expanded matrix partnering.
• All Utilization rates per thousand were met for Inpatient admissions, Inpatient Days and Outpatient visits, while goals were also met for Inpatient Readmissions and for Average Length of Inpatient stay.
• Metrics for the Outpatient Coaching and Case Management Programs were standardized and program availability to customers increased significantly due to newly expanded eligibility criteria.
• Web-based Family Awareness Programs were created for Autism, Eating Disorder, Bipolar Disorder, and Support to Families.

Assessment of Barriers

Clinical and administrative barriers remain and common barriers include:

• A lack of knowledge/insight on the part of the member for the need for treatment.
• A lack of follow-up by the behavioral health care professional or Cigna to remind and encourage members to keep appointments and comply with treatment regimens.
• Staffing needs in Case Management Programs and in the Advocacy department.
• Lack of accuracy of contact information for some customers for case management program outreach.
• Higher than expected utilization.
• Fewer than desired clinical improvements.

2014 Opportunities / Recommendations

Cigna's Behavioral Health Quality Committee made numerous recommendations for 2014 including:

• Re-examination of interventions for Antidepressant medical management, and continued work with health plan and matrix partners to improve outreach to professionals.
• Renewed focus on improving clinical rates.
• Monitor and improve condition-specific pathways for Utilization Management.
• Examine opportunities for improvements in coordination with primary care physicians.
• Build new metrics for chronically mentally ill.
• Build new metrics for medical-behavioral integration efforts.
• Build programs as required by new NCQA standards.

If you have questions, or would like to request additional information about Cigna's Behavioral Quality and Utilization Management Program, please contact your Professional Relations Representative. Cigna welcomes your input and suggestions for improvement to the Quality and Utilization Management Program.