1 / 5

CIGNA’s Behavioral Operations

CIGNA’s Behavioral Operations. 19M members: 53% “carved-in,” 47% “carved-out” EAP/Work-Life, Behavioral Benefits Management, Health and Wellness Services, Disease Management Programs Headquarters: Eden Prairie, MN 65K Network Providers 1100 Employees, 60% Clinicians

alvis
Download Presentation

CIGNA’s Behavioral Operations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CIGNA’s Behavioral Operations • 19M members: 53% “carved-in,” 47% “carved-out” • EAP/Work-Life, Behavioral Benefits Management, Health and Wellness Services, Disease Management Programs • Headquarters: Eden Prairie, MN • 65K Network Providers • 1100 Employees, 60% Clinicians • +600 Employees in Health Coaching and Disease Management (e.g. Nurses) • Process 4M+ Behavioral Claims per Year • 4K+ Employer Accounts

  2. Behavioral Benefit Designs in CIGNA’s Book-of-Business • 96% of large/medium employers have EAPs; all have MH/SA benefits • 20% of plans have no day/visit limits to MH/SA inpatient/ outpatient services (in network) • 70% of plans have MH/SA co-pays and co-insurance at or better than medical • Utilization comparison between parity/non-parity benefits shows little variation • Full parity across the book is projected to increase total medical and behavioral cost by 0.25% (in network), 0.4% (in and out of network).

  3. How Are MH/SA Benefits Managed at CIGNA? • No prior authorization for outpatient • Inpatient benefit “denials” <10% of cases (re-direct to partial or outpatient) • Pro-active care advocacy for specified critical conditions: • ADD/ADHD • Autism • Bi-Polar • Recurrent depression • Eating disorders • Substance abuse • Near benefit exhaustion • 25+ sessions/year

  4. CIGNA Book-of-Business Utilization: • 21 inpatient psych days/1000; Average LOS @ 5.4 days • 8.3 inpatient SA days/1000; Average LOS @ 5.9 days • Flat inpatient trend over five years • 362 psych visits/1000; • 12 outpatient SA visits/1000; • 33% presentation increase from 2003 but visits/1000 flat (i.e. more people entering treatment for shorter durations) • 1 out of 200 people who use MH/SA benefits exhaust their annual or lifetime coverage each year • SSRI costs approaching $4 pmpm • Anti-depressants rank third in total Rx cost (behind lipids and anti-ulcer) • 90% prescribed by PCPs

  5. CIGNA’s Policy Position on MH/SA • We support actions that reduce social stigma, broaden access to quality care, and prevent unnecessary costs in the health care system. • We support the integration of medical/behavioral clinical interventions and case management, and support initiatives that address the needs of consumers holistically. • The cost impact of parity is immaterial in a managed care setting, and parity benefits help reduce stigma and promote integration. • We support the current Senate version of parity because it reduces the administrative complexity and unnecessary cost of state-by-state variations in regulations. • We support coverage of treatments supported by clear scientific evidence. • We support transparency of provider performance and accountability for clinical outcomes. • We support open, competitive markets for MH/SA services and benefits management.

More Related