When employers select health plan networks for their employees, they may look at the pure size of a network and assume the more doctors, hospitals, and clinics that are included, the better. However, size alone does not equal quality. The quality of care a patient receives is critical in managing the total cost of care, which includes medical, pharmacy, and behavioral care costs.
“Improving health outcomes hinges on helping patients find high-performing doctors and quality sites of care.”Scott Filiault, senior vice president of affordability, governance and execution at Cigna.
Studies estimate that $760 billion to $935 billion of the money spent each year in the United States is wasted on overtreatment or low-value care, representing as much as 25% of total health care expenditures.
For employers, guiding employees to more effectively navigate the complexity of health care has never been more paramount. Ensuring employees have access to the right care, at the right place, and at the right time can improve health outcomes and help employees be happier and healthier. That's crucial to business productivity and overall success.
Health Plans Designed to Lower Health Care Costs
Employers and other plan sponsors can easily assess location, price, and other variables when selecting networks. Whereas the quality of a network may be more difficult to determine. At Cigna, we evaluate quality and cost-efficiency information for 21 provider specialties, including cardiology, internal medicine, and general surgery. Doctors are evaluated on a number of criteria, including board certification, adherence to evidence-based rules, and National Committee for Quality Assurance (NCQA) physician recognition. We then share our findings with employers, plan sponsors, patients, and providers through our public and customer websites.
“Providing access and transparency to information enables our customers to make informed health care decisions for their employee-base,” Filiault said. “Access to the right care, in the right setting, at the right time addresses better coordinated care, a better experience for the patient, and better outcomes across the health care system, which simultaneously improves cost.”
Our health care plan solutions and programs are designed to get patients to high-performing providers and sites of care. Our approach to value-based care means we collaborate with high-performing doctors to create the right incentives that further improve their performance and help them deliver more personalized care. For example, Cigna Tiered Benefits was developed as a tool to get patients to higher-performing providers who have been evaluated for quality, cost efficiency, and volume. Patients who use these high-value (“Tier 1”) providers get lower out-of-pocket costs beyond the standard in-network benefit level.
Additionally, consumer-driven health plans, which allow employers, employees, or both, to set aside pretax money through health reimbursement accounts (HRA) and health savings accounts (HSA) to pay for qualified medical expenses are also of great benefit for patients and plan sponsors alike. A Cigna study showed that employers who choose to offer consumer-directed health plans could see medical costs decrease by 12% on average in the first year. Cigna Choice Fund is an example of a true consumer-focused solution. It puts the individual’s needs and goals first, creating engaged customers who take appropriate action to improve their health and reduce medical costs.
Cigna's incentives program – which is designed to support and reward customers when they take key steps to be healthy – is our effort to motivate and support customers to prioritize their health. For example, customers get financial incentives to reach their target numbers (for Body Mass Index, blood pressure, total cholesterol, and more), by working with a health coach to improve their results by participating in qualified exercise or weight management programs or for completing their annual physical/wellness exam.
Making it Easy to Find and Receive Quality Care
We are constantly expanding our networks to provide new sites of care that connect patients with high-performing providers, while saving plan sponsors money.
For example, many specialty medications, which are used to treat costly and complex conditions like cancer, must be injected or infused by a nurse or provider and costs can vary widely from one site of care to the next. While providers can direct patients to infusion therapy sites in large hospital settings, research shows hospitals often charge double for the same drug compared to specialty pharmacies. Cigna has developed the Cigna Specialty Care Options Plus (SCO Plus) solution to enhance the experience for patients taking an injectable or infused specialty oncology medications by helping them get their treatment at in-network, local infusion center that is safe, convenient and more affordable.
Virtual care is another example of how Cigna makes accessing providers more convenient and more cost effective. All Cigna health plan customers have access to virtual primary care, urgent care, behavioral care, and dermatology appointments from MDLIVE, an Evernorth company. Another benefit of virtual care is that it enables patients and plans to avoid unnecessary lab tests, saving the patients’ time and allowing them and their plans to avoid unneeded expenses. A recent Cigna actuarial study found that patients who saw MDLIVE providers during urgent care visits avoided unnecessary tests, saving an average of $118 for each episode of care. Our intent with virtual care is not to replace the patient-provider relationship; Virtual care is meant to complement in-person care. It’s really about making accessing care simple and easy to ensure people get the care they need when they need it, at an affordable price.
Working Together to Reduce the Total Cost of Care
It’s no secret that when employees thrive, so do their employers. A study by the Economist, which was commissioned by Cigna, found that a healthy workforce increases morale and motivation by 37%, enables 45% more productivity, and increases retention and loyalty by 37%.
By working together, employers, employees, and health plans can improve population health and manage the total cost of care. At the end of the day, network size is an important factor. However, it’s the partnership between employers and health plans, health plans and high-performing health care providers, and the engagement of employees in their own health that most drive good health outcomes, while keeping costs in check.
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