According to the Centers for Disease Control and Prevention (CDC), health equity can only be achieved when all people have the same opportunities to reach their full health potential, regardless of their socially determined circumstances.

Unfortunately, that is not currently the state of affairs in the United States. Consider the following:

• COVID-19 data shows that Black, Hispanic, Native American, and Alaska Native people in the United States have experienced higher rates of COVID-19-related hospitalizations and deaths compared with non-Hispanic white populations.
• Research shows that the LGBTQ+ community has less access to care, are less likely to have health insurance and are more likely to report unfair treatment by health care providers.
• Asian Americans have one of the highest rates for psychiatric disorders yet are three times less likely to seek mental health services than whites.

These are just a few of the disparities in health care in the U.S. today. As a health services organization, Cigna's mission is to improve the health, well-being, and peace of mind of those we serve – which includes making sure every person has the opportunity to achieve their full health potential, regardless of social, economic, or environmental circumstances. We put money and resources into fulfilling this mission.

Enter Cigna's Coverage Policy Unit (CPU), a team of individuals dedicated to embedding health equity into Cigna's culture, systems, policies, and practices.

“The team is making health equity a part of how we do business.”Dr. Julie Kessel, coverage policy medical officer at Cigna

The CPU team is responsible for the development, assessment, implementation and maintenance of all medical, drug and biologic, reimbursement, modifier, administrative and precertification policies for our organization. It develops coverage policies to ensure transparent, consistent, industry-standard, and evidence-based guidelines are applied and medically appropriate therapy is received by all Cigna patients.

Applying a Health Equity Lens to Coverage Policy

Clinical objectives have traditionally taken an evidence-based approach that relies on supported literature and industry standards. However, a notable shift, pivoting toward a more holistic approach, has emerged when tackling complex medical care. This progressive methodology has led Dr. Kessel’s team to embed health equity into their work.

In 2020, the unit adopted five guiding principles to apply a health equity focus to coverage policy development at Cigna:

1. Addressing health equity is customer-centric.
2. Addressing heath equity and health disparities promotes affordability.
3. Consistent evidence standards and safety thresholds are foundational.
4. Health literacy, cultural competency, and the social determinants of health all impact health equity.
5. Language simplification furthers health equity by making information easier to understand and use.

As the unit began to employ these principles, notable changes and recommendations began to shape current and prospective policies, leading to some bold and exciting changes.                                                         

Walking the Walk: Creating More Equitable Coverage Policies

In 2021, the CPU observed a health disparity in the prevalence of uterine fibroids and therapeutic options, especially among Black women. Twenty six million women in the US have uterine fibroids, which are benign, non-cancerous growths in the uterus that lead to chronic pain and other complications. Black women are three times more likely to have this condition, at a younger age, and tend to have larger and more numerous tumors than other racial groups.  

Under Cigna’s former coverage policy, ultrasound-guided radiofrequency ablation (RFA) was not an approved therapeutic option for uterine fibroids. A majority of payers were not covering it. Instead, hysterectomies and surgical fibroid removal were given more consideration, despite the fact that Black women experience increased negative side effects from these types of procedures than they do from RFA. 

The CPU team consulted with the American College of Obstetricians and Gynecologists and reviewed a subgroup analysis that suggested benefits of RFA, and there were no major safety signals. The team decided to change our coverage position to expand access to this minimally invasive treatment option for all women. This is just one of the many examples of the type of change that the CPU team is driving.

Helping Reduce Gaps in Quality Care

Because of work by Dr. Kessel and her unit, an observed bias has been diminished and women have access to the treatment they need. Application of a health equity lens to important policy work has led to the assurance that all women have access to RFA, which will hopefully improve health care quality for all, and make health outcomes more equitable. This progress delivers on our promise to understand our customers’ needs to help them achieve healthier, more secure lives.