Cigna 2011 Annual Report Download - page 31

9CIGNA CORPORATION2011 Form10K
PARTI
ITEM 1 Business
Quality Medical Care
Cigna HealthCare’s commitment to promoting quality medical care to
its customers is reected in a variety of activities including: credentialing
medical health care professionals and facilities that participate in Cigna
HealthCare’s managed care and PPO networks as well as developing the
Cigna Care Network
SM
specialist physician designation described below.
Participating Provider Network
Cigna HealthCare has an extensive national network of participating
health care professionals that consisted of approximately 5,600hospitals
and approximately 667,400health care professionals as of
December31,2011 as well as other facilities, pharmacies and vendors
of health care services and supplies.
In most instances, Cigna HealthCare contracts directly with the
participating hospital, health care professional or other facility to provide
covered services to customers at agreed-upon rates of reimbursement. In
some instances, however, Cigna HealthCare companies contract with
third parties for access to their provider networks and care management
services. In addition, Cigna HealthCare has entered into strategic alliances
with several regional managed care organizations (Tufts Health Plan,
HealthPartners,Inc., Health Alliance Plan, and MVP Health Plan) to
gain access to their provider networks and discounts.
Cigna Medical Group
Cigna Medical Group (CMG) is the multi-specialty medical group
practice division of Cigna HealthCare of Arizona,Inc. which delivers
primary care and certain specialty care services through 25medical
facilities and approximately 194employed clinicians in the Phoenix,
Arizona metropolitan area. Eighteen of these multi-specialty health care
centers and their aliated primary care physicians have received the top
level (level3) of accreditation from NCQA (Patient Centered Medical
Homes). CMG currently holds the highest level of this accreditation for
the greatest number of practices and physicians in the state of Arizona.
Cigna Care NetworkSM
Cigna Care Network is a benet design option available for Cigna
HealthCare administered plans in 68service areas across the country.
Cigna Care Network’s designated physicians are a subset of participating
physicians in certain specialties who are so designated based on specic
clinical quality and cost-eciency selection criteria. Customers pay
reduced co-payments or co-insurance when they receive care from a
specialist designated as a Cigna Care Network provider. Participating
specialists are evaluated regularly for the Cigna Care Network designation.
Provider Credentialing
Cigna HealthCare credentials physicians, hospitals and other health care
professionals in its participating provider networks using quality criteria
which meet or exceed the standards of external accreditation or state
regulatory agencies, or both. Typically, most health care professionals
are re-credentialed every three years.
External Validation
Cigna continues to demonstrate its commitment to quality and has
expanded its scope of external validation of its quality programs
through nationally recognized accreditation organizations. Each of
Cigna’s 36PPO/OAP markets and 22 of the HMO and POS plans
that have undergone an accreditation review have earned Excellent or
Commendable status from the NCQA, a private, nonprot organization
dedicated to improving health care quality. In addition, Cigna’s provider
transparency, wellness, utilization management, case management and
demand management programs have been awarded the highest outcomes
possible. From NCQA, Cigna earned Physician & Hospital Quality
Certication and Wellness and Health Promotion Accreditation. From
URAC, an independent, nonprot health care accrediting organization
dedicated to promoting health care quality through accreditation,
certication and commendation, Cigna has full accreditation for
Health Utilization Management.
HEDIS® Measures
In addition, Cigna HealthCare participates in NCQA’s Health Plan
Employer Data and Information Set (“HEDIS®”) Quality Compass
Report, whose Eectiveness of Care measures are a standard set of metrics
to evaluate the eectiveness of managed care clinical programs. Cigna
HealthCare’s national results compare favorably to industry averages.
Accountable Care Organizations
Cigna has collaborated with 18accountable care organizations, and
expects to continue to expand these arrangements. e overall objective
of these organizations is to improve the quality of care and service
experience for customers while lowering their costs and improving
overall value. e goal in collaborating with an accountable care
organization is to identify health care delivery organizations (medical
groups and hospital organizations) that can coordinate end-to-end care
for a dened population of patients.
Markets and Distribution
Cigna HealthCare oers products in the following markets:
•
National segment - these employers have 5,000 or more U.S.-based,
full-time employees living in two or more states.
•
Middle Market segment– comprised of employers with 250 to 4,999
U.S.-based, full-time employees located in one or more states with a
majority of their full-time employees living and working in the same
state. is segment also includes single site employers with more
than 250employees, Taft-Hartley plans and other third party payers.
• Select segment - focuses on employers with 51-249eligible employees
and provides ASO and guaranteed cost funding solutions. Select also
provides ASO funding to employers with a minimum of 25employees.
• Individual - Cigna HealthCare actively markets health and dental
insurance to individuals in ten states as of December31,2011, including
Arizona, California, Colorado, Connecticut, Florida, Georgia, North
Carolina, South Carolina, Tennessee and Texas.
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