Cigna Boosts Outcomes Despite Affordable Care Act Obstacles

August 18, 2016 - With many health payers experiencing significant challenges while operating through the health insurance exchanges and adhering to various provisions of the Patient Protection and Affordable Care Act, it grows more important than ever before to address what some payers are doing right in the turmoil as the country transitions to new forms of payment and coverage expansions.

With Aetna and UnitedHealthcare leaving a large chunk of their operations within the public health insurance exchanges, it is beneficial to consider the actions taken by other payers to boost patient outcomes and satisfaction while reducing healthcare spending. HealthPayerIntelligence.com spoke with representatives from Cigna and the QualCare Alliance Network Inc. to gain knowledge about how this payer addresses the challenges of adhering to the Affordable Care Act.

For example, Cigna and its subsidiary QualCare Alliance Network Inc. have implemented new data analytics technology to cut wasteful spending and improve health outcomes among its patient base, explained Annette Catino, President and Chief Executive Officer of QualCare Alliance Network, Inc., and Mike Koehler, Market President for Cigna South Texas.

“So over a year ago, Seton Health announced that it was entering into a joint venture with Cigna Healthcare to form a local health insurance product that Seton and Cigna together would take to market to help local employers deal with the high cost of insurance and issues with access to care,” Catino explained. “The belief was that a local alternative driven by a provider-sponsored entity (Seton Insurance) could be a more effective way of bringing a local product to market that could be at a lower cost and could improve both quality and access to the patients.”

The healthcare provider network responsible for using data from the analytics technology in order to manage its hospitals and physician groups is the Seton Healthcare System and Jeff Cook, Seton’s President and CEO of Insurance Services, offered some perspective on the importance of transitioning to population health management and accountable care within the new value-based care environment providers are finding themselves in.

“We’re a large hospital system in Austin, Texas. We have 12 hospitals and about 500 employed physicians through our system. We’ve spent a lot of time getting into population health. We’ve realized that economics are changing and the system of care needed to change. Back in 2012, we started an ACO called Seton Health Alliance and we were one of the Pioneer ACOs,” added Cook. “That’s how we launched our provider network into the value-based space. Since then, we’ve grown the ACO quite a bit. We have about 2,400 physicians and about 100,000 lives that we manage under value-based payment.”

“We thought the best opportunity to succeed in the commercial space was to move forward with a national carrier because, on the provider side, we have the ability to transform care and the way care is delivered,” Cook continued. “We have access to all the clinical information through our electronic medical records. We bring a lot to the table including the trust and relationships we’ve developed with patients across central Texas.”

When asked how the data analytics technology cut costs for Cigna and boosted patient outcomes, Mike Koehler responded, “Cigna is a global organization and, as we look at relationships starting with the people who buy our products - employers, employees, and family members - one of the things we’ve identified is that it’s vital to build stronger relationships with the providers of care - they’re the closest to the patient experience.”

“As we have evolved our relationships with physicians and hospital systems over the years, we’ve looked at trying to find partners who speak the same language that we do around producing higher value, better outcomes, and more cost efficiency,” Koehler added.

“In the early stages [of our partnership with Seton Health], it was identified very quickly that we could finish each other’s sentences and spoke the same language. We had the same vision for the future. It really became pretty easy to build our relationship. One of the themes in the process of building this, it has to generate a better experience for the patients and the employers. We were able to accomplish that by picking the things that Cigna and Seton does best and eliminating the duplication and waste that exists. This generated a different patient experience.”

The two companies have worked to reduce wasteful spending and duplicative testing by using data from claims and pharmacy accounts to really put the information into an “actionable format,” Catino said. She explained how the “beauty” of this partnership has been to take into account physician clinical data, hospital data, and claims information to create a more actionable process that allows payers and providers “to reach out to patients and make interventions.”

When it comes to the future of Cigna and the trends on the horizon for this payer, Jeff Cook explained that, “In the context of the Seton relationship, irregardless of whether it’s an individual who is buying health insurance through the exchange or through Medicare or Medicaid or commercial, the only way we can build a system of care that brings together the data and the patient experience is by aligning all the parties who are part of this equation.”

“This is our position in the market,” Cook continued. “To create the kind of model we’re seeking, we need to put all the pieces together to reduce costs, improve outcomes, and bring more value. I think this is a great example of how we were able to partner to improve healthcare for everybody.”

Currently, the health insurance industry is undergoing some inner turmoil due to the transitions required by the Affordable Care Act. Some large payers have begun dropping out of the health insurance exchanges while others have increased the costs of their premiums and out-of-pocket spending.

When asked how Cigna is keeping consumer satisfaction a priority and addressing the issues of the Affordable Care Act, Cigna’s Mike Koehler answered, “I think a theme that exists, and why it’s not a simple two-sentence answer, is that healthcare is local. A resident of Texas versus a resident in New Jersey or Arizona, there are going to be some things they have in common, but a lot of things will be unique for that market and for that patient.”

“To have the ability to flux into the market to make the outcomes and the quality to work in that market requires a company like Cigna to have flexibility,” he concluded. “There may be different model between states. To be able to have that flexibility, commitment, and to have the core operating principles where customers come first, that translates into what we’re about.”

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