Gaps in Care Programs

Gaps in Care: A Comprehensive Program to Help Improve Wellness

Our comprehensive gaps in care program is made up of RationalMed for Cigna and Well Informed. Using these two solutions together, we can identify risks, potential adverse events, and care improvement opportunities to help drive improved wellness for your patients with Cigna-administered coverage. Both programs use medical, pharmacy, and laboratory data to identify potential gaps in care. As a result, customers with chronic illnesses as well as those with acute conditions will benefit.

In addition, as a provider, you'll benefit, too. This is because you can consider our expanded findings when making decisions about your patients' treatment plans. Through these programs, our goals are to support your efforts, help your patients make better health decisions, and prevent unnecessary and costly hospitalizations.

Note that the alerts from each of these programs will be different just as the phone numbers are different.

About Well Informed

This program helps us identify disease prevention and improvement opportunities by addressing potential gaps in care, which may include the following:

  • Medication adherence
  • Patient safety
  • Achievement of key clinical targets
  • Monitoring
  • Appropriate therapy or drug

We notify both you and your affected patients of any identified gaps and provide personalized instructions to help reduce and close them.

For more information about Well Informed, please call Cigna Customer Service at 800.88Cigna (882.4462).

About RationalMed for Cigna

RationalMed for Cigna is administered by Express Scripts. This program complements Well Informed by helping us identify additional risk-reduction opportunities related to potential gaps in care, such as the following:

  • Adverse drug disease consideration
  • Adverse drug interaction
  • Dose duration consideration
  • Customer age consideration
  • Drug and pregnancy complication consideration
  • Drug therapy duplication
  • Duration consideration
  • Excessive dosing
  • High-risk medications
  • Pharmacogenomics
  • Quantity considerations
  • Misuse/abuse
  • Polypharmacy
  • Under dosing

When we identify gaps, we provide you with timely, actionable data to help you decide whether any changes in therapy are necessary. Note that we will not send information to patients.

We send RationalMed for Cigna messages through your electronic medical record (EMR) or by letter or fax. In addition, prescribing pharmacists will receive alerts to help ensure care is coordinated across your patients’ health care team.

For more information about RationalMed for Cigna, please call Express Scripts Pharmacy, a Cigna company, at 800.717.6630.