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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

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CIGNA’s Behavioral Operations

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  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.

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