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Cigna’s Key Principles for Healthcare Quality Measures

The health insurer Cigna follows standardized healthcare quality measures and collaborates with provider networks to ensure quality improvement.

By Vera Gruessner

Cigna is one national health insurance company that has moved forward with creating successful healthcare quality measures for their provider networks.

Healthcare Effectiveness Data Information Set (HEDIS)

The company uses national standards along with physician feedback when creating its own healthcare quality measures, according to a Cigna white paper. Cigna implements a few key principles when providing consumers and employers with provider quality and cost information including:

1) Standardized healthcare quality measures

2) Responsible use of quality data to assist with consumer decision-making

3) Collaboration and enabling quality improvement

Cigna like other payers follows the standardized measures from the Healthcare Effectiveness Data Information Set (HEDIS) as well as the benchmarks endorsed by the National Quality Forum (NQF). Industry-standard methodology is also used to find the average cost of treatment for an episode of care for various services and surgical procedures.

The cost for episodes of care are then compared to other medical groups in the same specialty and geographic market. The final information is available for members to see in an online healthcare professional directory, according to the white paper.

“Cost-efficiency stars are used to communicate cost-efficiency performance,” the Cigna white paper stated. “Three stars for cost-efficiency represent the top 34 percent of physicians or physician groups when compared to other physicians and physician groups of the same group specialty type within the geographic market. Two stars represent physicians or physician groups in the middle 33 percent for cost-efficiency. Physician groups that are in the lower 33 percent for cost efficiency receive one star.”

Additionally, the payer encourages their members to consult with their primary care doctors and consider all factors when deciding on a specialist or hospital for their care. Cigna also offers their provider networks with summary metrics and data to help physician groups improve their overall performance.

In order to inform consumers on healthcare quality measures of their primary care physician groups and specialists, Cigna provides an evaluation through an online member portal.

The health insurer also works with other healthcare organizations to improve upon quality standards. For example, last May, Cigna announced in a company press release a partnership with the American Society of Addiction Medicine (ASAM) to analyze two years of member claims regarding substance use in order to enhance treatment for those suffering from drug addiction.

The claims data are going to be used to test and improve ASAM’s healthcare quality measures regarding medication prescribing practices and opioid and alcohol use disorders. Improving treatment for substance abuse disorders is a major goal of Cigna and the healthcare industry as a whole since approximately 2.1 million people face opioid and other substance use disorders and more than 28,000 Americans die from opioid overdoses annually.

“Cigna looks forward to collaborating with ASAM to help modernize how our industry treats people with substance use disorders,” said Cigna President and CEO David M. Cordani. “We must accelerate the adoption of evidence-based approaches in clinical practice, and transform the current treatment model to one that is based on national standards and is more prevention-focused.”

“Cigna and ASAM’s collaboration demonstrates action and leadership at a time when there is an increasing call for change in how policymakers, providers, communities and families address the drug epidemic in the United States,” Cordani continued.

ASAM has published nine performance quality measures to analyze how physicians are treating substance use disorders. Cigna and ASAM will be publishing a report once the study of the claims data is completed and the healthcare quality measures have been tested.

Other payers can follow Cigna’s lead and work with healthcare organizations to improve national healthcare quality measures in growing disease management areas like opioid use disorders.

Additionally, payers would benefit from implementing standardized quality metrics and collaborating with provider networks to ensure clinicians are able to progress with quality improvement efforts. When attempting to improve member engagement and improve transparency, payers are advised to implement member portals where data on cost and quality is shared.

By following the steps that Cigna implements in advancing the use of healthcare quality measures, insurers could successfully boost member engagement and provider quality improvement strategies.


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