Cigna 2012 Annual Report Download - page 26

PART I
ITEM 1 Business
healthier life; 3) Cigna’s Well Informed program, that uses clinical
Government
rules-based software to identify potential gaps and omissions in
Medicare Advantage. Cigna offers Medicare Advantage coordinated customers’ health care by analyzing integrated medical, behavioral,
care plans in 13 states and the District of Columbia. Under a pharmacy and lab data allowing Cigna to communicate the gaps to
Medicare Advantage plan, Medicare-eligible beneficiaries may receive customers and their doctors; and 4) an array of health coaching
health care benefits, including prescription drugs, through a managed offerings to address lifestyle management issues such as stress, weight,
care health plan such as the Company’s coordinated care plans, and and tobacco cessation.
the Centers for Medicare and Medicaid Services (‘‘CMS’’) reimburse
Cost Containment Service. Cigna administers cost containment
the Company pursuant to a risk adjustment payment methodology.
programs for health care services and supplies that are covered under
Cigna ensures that our Medicare Advantage customers receive quality
health benefit plans. These programs, that may involve contracted
medical care through our innovative plan models that focus on
vendors, are designed to control health costs by reducing
developing highly engaged physician networks, aligning payment
out-of-network utilization, including educating customers regarding
incentives to improved health outcomes, and using timely and
the availability of lower cost in-network services, reviewing provider
transparent data sharing. Approximately 75% of our Medicare
bills, and recovering overpayments from other insurance carriers or
Advantage customers are served by physicians in these innovative
health care professionals. Cigna charges fees for providing or
models, and Cigna is focused on expanding these models in the
arranging for these services.
future. The HealthSpring acquisition expanded the size of Cigna’s
Medicare Advantage customer base. As of December 31, 2012,
HealthSpring represented 89% of Cigna’s Medicare Advantage
Behavioral Specialty
customer base. Cigna also offers Medicaid coverage to low income
individuals in selected markets in the U.S. Cigna’s Medicaid Behavioral Health. Cigna arranges for behavioral health care services
customers benefit from many of the coordinated care aspects of the for customers through its network of participating behavioral health
Company’s Medicare Advantage programs discussed above. care professionals. Cigna offers behavioral health care case
management services, employee assistance programs (EAP), and
Medicare Part D. Cigna’s Medicare Part D prescription drug work/life programs to employers, government entities and other
program provides a number of plan options as well as service and groups sponsoring health benefit plans. Cigna Behavioral Health
information support to Medicare and Medicaid eligible customers. focuses on integrating its programs and services with medical,
Cigna’s Part D plans are available in all 50 states and the District of pharmacy and disability programs to facilitate customized, holistic
Columbia. These plans offer the savings of Medicare combined with care.
the flexibility to provide enhanced benefits and a drug list tailored to
individuals’ specific needs. Retirees benefit from broad network access As of December 31, 2012, Cigna’s behavioral network had
and value-added services that help keep them well and save them approximately 118,000 access points to independent psychiatrists,
money. The HealthSpring acquisition expanded the size of Cigna’s psychologists and clinical social workers and approximately 9,800
Medicare Part D customer base. As of December 31, 2012, facilities and clinics that are reimbursed on a contracted fee-for-service
HealthSpring represented 49% of Cigna’s Medicare Part D customer basis.
base.
Cigna Pharmacy Management
Specialty Products
Cigna Pharmacy Management. Cigna Pharmacy Management offers
prescription drug plans to its insured and self-funded customers both
Medical Specialty
in conjunction with its medical products and on a stand-alone basis.
Health Advocacy. Global Health Care offers a wide array of medical With a network of over 64,000 contracted pharmacies, Cigna
management, disease management, and other health advocacy services Pharmacy Management is a comprehensive pharmacy benefits
to employers and other plan sponsors to help individuals improve manager (PBM) offering clinical integration programs, specialty
their health, well-being and sense of security. These services are pharmacy solutions, and fast, efficient home delivery of prescription
offered to customers covered under Global Health Care’s administered medicines.
plans or plans insured or administered by competing insurers or third-
Programs that facilitate this integration of medical, behavioral and
party administrators. Cigna offers seamless integration of services that
pharmacy offerings include the Well Informed program, that is focused
address the clinical and administrative challenges inherent in
on chronic conditions requiring strict compliance with a prescription
coordinating multiple vendors. Through its health advocacy
drug therapy such as asthma, diabetes, back pain or high cholesterol,
programs, Global Health Care works to help healthy people stay
as well as Step Therapy, that encourages customers to use generic
healthy; help people change behaviors that put their health at risk; and
and/or preferred brand drugs rather than higher cost brand-named
assist those with problems in accessing quality care.
drugs. Step Therapy is implemented through claim management
Health advocacy programs and services include: 1) early intervention protocols, that may include communications with customers and
by Cigna’s network of clinical professionals; 2) Cigna’s online health their physicians. The Company coordinates pharmacy management
assessment, powered by insights and analytics from the University of with all of Cigna’s health advocacy programs and tools by focusing on
Michigan Health Management Research Center, that helps customers patient education, including emphasizing the importance of adhering
identify potential health risks and learn what they can do to live a to medication instructions.
4 CIGNA CORPORATION - 2012 Form 10-K