Cigna 2015 Annual Report Download - page 37

PART I
ITEM 1. Business
Cigna Collaborative Care. cost-efficiency criteria. Customers in Cigna Care Network plans pay
reduced co-payments or co-insurance when they receive care from a
Collaborative Accountable Care (‘‘CAC’’) – currently we have over specialist designated as a Cigna Care Network physician. Participating
140 collaborative care arrangements with large primary care specialists are evaluated regularly for the Cigna Care Network
groups built on the patient-centered medical home and designation.
accountable care organization (‘‘ACO’’) models. Our CAC
arrangements span 29 states and reach 1.6 million customers and LocalPlus is a provider network of doctors and hospitals designed to
we are committed to increasing the number of CACs over the provide cost-effective and quality care by limiting the network to
next several years. Our goal is to reach 165 of these programs in select health care providers and facilities. We currently offer LocalPlus
2016. in 16 markets and will expand this approach in additional markets in
2016.
Hospital Quality Incentive Program – compensation paid to 300
hospitals is tied to quality metrics and we expect to add 50 to100
Medical Care and Onsite Services
hospitals over the next two years.
Cigna Medical Group is a multi-specialty medical group practice
Specialty Care Collaboration Program – we continue to develop that delivers primary care and certain specialty care services through
arrangements with specialists including programs such as 23 medical facilities and 150 clinicians in Phoenix, Arizona. These
National Obstetrics/Gynecology and our program to reimburse health care centers have received the highest accreditation (level 3)
providers for individual ‘‘episodes of care’’ (services performed to from the National Committee for Quality Assurance (‘‘NCQA’’).
treat a specific medical condition).
•LivingWell Health Centers. Medicare Advantage customers may
Patient Care Collaboration Program – we are developing a program receive care from one of our five free-standing clinics and eight
which will engage small physician practice first by providing ‘‘embedded’’ clinics that incorporate the principles and resources of
them with actionable patient information to improve outcomes. stand-alone clinics while allowing the customer access to their
We anticipate piloting with select physicians in a few markets in primary care physician.
2016.
Cigna Onsite Health provides employer-based onsite or nearby
Independent Practice Associations are innovative physician health centers and health and wellness coaches with nearly 50 health
engagement models in our Cigna-HealthSpring business that allow centers and 140 health coaches. Care delivery services include acute,
the physician groups to share financial outcomes with us. The episodic care, primary care, health and wellness coaching programs
Cigna-HealthSpring clinical model also includes outreach to new and biometric screenings. Virtual Health care services are also
and at-risk patients to ensure they are accessing their primary care available to help extend access to care for both coaching and
physician. treatment services.
•Delivery System Alliances. Cigna and select health care providers
are collaborating to develop products to improve the experience of
External Validation
Cigna customers by offering integrated health care and providing
We continue to demonstrate our commitment to quality and have a
access to quality, value-based care in local communities.
broad scope of quality programs validated through nationally
recognized external accreditation organizations. We maintained
Participating Provider Network
Health Plan accreditation from the NCQA in 37 of our markets.
We provide our customers with an extensive network of participating Additional NCQA recognitions include Full Accreditation for
health care professionals, hospitals, and other facilities, pharmacies Managed Behavioral Healthcare Organization for Cigna Behavioral
and providers of health care services and supplies. In most instances, Health, Accreditation with Performance Reporting for Wellness &
we contract with them directly; however, in some instances, we Health Promotion, Accreditation for our wellness programs and
contract with third parties for access to their provider networks and Physician & Hospital Quality Certification for our provider
care management services. In addition, we have entered into strategic transparency program. We have Full Accreditation for Health
alliances with several regional managed care organizations (e.g., Tufts Utilization Management, Case Management, Pharmacy Benefit
Health Plan, HealthPartners, Inc., Health Alliance Plan, and MVP Management and Specialty Pharmacy from URAC, an independent,
Health Plan) to gain access to their provider networks and discounts. nonprofit health care accrediting organization dedicated to promoting
health care quality through accreditation, certification and
We credential physicians, hospitals and other health care professionals commendation.
in our participating provider networks using quality criteria that meet
or exceed the standards of external accreditation or state regulatory We participate in the NCQA’s Health Plan Employer Data and
agencies, or both. Typically, most health care professionals are Information Set (‘‘HEDIS’’) Quality Compass Report, whose
re-credentialed every three years. Effectiveness of Care measures are a standard set of metrics to evaluate
the effectiveness of managed care clinical programs. Our national
The Cigna Care Network, a benefit design option available in 72 results compare favorably to industry averages.
markets across the U.S., is a subset of participating specialist
physicians designated based on specific clinical quality and
CIGNA CORPORATION - 2015 Form 10-K 7
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