Cigna

CA group announces 2007 P4P results

Anne Zieger — Mon, 06 Oct 2008 01:08:25 -0400

California healthcare group Integrated Healthcare Association has announced the 2007 pay-for-performance program results and performance award winners. The IHA found that clinical quality and information technology use showed improvement, while patient experience scores stayed about the same.

The 2007 measurement results were used by seven health plans to calculate incentive payments for physician groups in 2008. The health plan participants include Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA HealthCare, Health Net of California, Western Health Advantage and UnitedHealthcare.

IHA offered two sets of performance awards, including one recognizing 46 physician groups with the best overall performance on quality measures including preventive care, chronic care management, and use of IT to support safer care. The second set of awards recognized 11 groups demonstrating the most quality improvement in their region.

To learn more about the awards:
- read this Healthcare IT News piece

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Health plan quality improves, while federal payers lag

Anne Zieger — Fri, 03 Oct 2008 14:36:25 -0400

Over the last nine years, the quality of care delivered to patients enrolled in health plans submitting data to the National Committee for Quality Assurance has continued to improve, though federal payers are lagging behind, according to a new NCQA report. The NCQA accredits and measures health plans using a list of clinical measures tracking how often appropriate care is delivered. Nearly half of 202 million Americans in the commercial insurance market are enrolled in plans that measure quality and report to the NCQA. Data for this year's report came from 2007 and tracked 845 plans.

According to the report, commercial plans that submitted HEDIS data (Healthcare Effectiveness Data and Information Set) showed increases on 44 of 54 quality measures, including asthma med management, blood pressure control and postpartum care for infants. Private Medicare plans also showed improvements, including in management of medications and treatment after heart attacks. However, traditional Medicare plans only showed improvement for 24 of 45 measures, and Medicaid on 26 of 52.

To learn more about the report:
- read this Modern Healthcare article (reg. req.)

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SC Medicaid plans to stop paying for errors

Anne Zieger — Mon, 25 Aug 2008 13:37:40 -0400

Another plan has joined the "no pay for errors" parade: This time, it's South Carolina's Medicaid program, which covers about 800,000 South Carolinians. Officials with the program say that they won't stop making such payments to hospitals right away, however, as they have some technical questions to address before stopping such payments. The South Carolina Hospital Association has already adopted principles encouraging hospitals not to bill for certain mistakes, but participation is voluntary.

In making such a decision, the South Carolina Medicaid plan is joining a growing list of its health plan peers, including the New York, Massachusetts and Pennsylvania Medicaid plans, Medicare, CIGNA, Aetna and a number of Blue Cross Blue Shield affiliates. Meanwhile, hospitals in nearly half of states have agreed not to bill for never events.

To learn more about this decision:
- read this piece from the Associated Press

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Cigna Q2 profit shoots up 37 percent

Anne Zieger — Fri, 01 Aug 2008 09:54:08 -0400

While last quarter was pretty much a gloom and doom situation for health plans, this quarter is shaping up better for the industry. Yesterday, we noted that Aetna's second-quarter profits had grown a respectable 10 percent. Now the story is Cigna, whose Q2 '08 income climbed a more-impressive 37 percent over the same period last year. Its net income was $272 million for the second quarter, up from $198 million one year ago. Revenue, meanwhile, rose 11 percent to $4.86 billion from $4.38 billion.

Cigna's income growth came from several sources, including a 19 percent growth in medical membership over the first half of the year, and premium fees climbed 13 percent. Both were fueled partly by the company's April 1 acquisition of Great-West Healthcare. Part of the reason it's doing well financially is that it has less exposure to the commercial risk market than some of its competitors, as it offers fixed-fee products like disability and life insurance. In its health sector, the company offers not only medical coverage, but also behavioral, dental, disease management and pharmacy-related products and services.

To learn more about Cigna's results:
- read this Cigna press release
- read this Wall Street Journal piece (sub. req.)

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Express Scripts, Cigna agree to $27M 'drug switching' settlement

Express Scripts, Cigna agree to $27M "drug switching" settlement

Anne Zieger — Wed, 30 Jul 2008 11:59:57 -0400

Pharmacy benefits manager Express Scripts and health plan Cigna have settled a New York state lawsuit over alleged "drug switching" for a total of $27 million. The suit, which was filed in 2004, involved a pharmacy benefits management contract between the New York state employee health plan, Express Scripts and Cigna. In the suit, the state alleges that Express Scripts--serving as the pharmacy benefit manager for plan members--recommended that patients switch to higher-cost drugs to boost its profits. Under the terms of the settlement, Express Scripts said that it doesn't engage in drug switching, nor does it accept pharmaceutical funding for such programs. However, other state governments believe it does. In May, Express Scripts settled with 28 other states for $9.5 million.

To learn more about the settlement:
- read this Modern Healthcare piece

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Trend: Medical home funding sources grow

Anne Zieger — Mon, 21 Jul 2008 14:35:22 -0400

While the notion of a "medical home" has been bubbling up through the healthcare industry for some time, it's still something of a new idea for many consumers, who've never lived in an era when primary care physicians had the time for leisurely visits. However, with the passage of the new Medicare bill--which authorizes funding for a three-year medical home project--and a growing list of state and federal projects fostering this approach, consumers may yet find out.

One example of the coming changes can be found in Philadelphia's metro, where 100 physicians are getting extra payments from some of the region's largest insurers to work more closely with 8,400 patients. (Participating health plans include Independence Blue Cross, Aetna and Cigna.) That includes not only traditional visits, but also e-mail and telephone care. Insurers are running similar pilot programs in several states, in programs impacting nearly 2 million patients and thousands of doctors.

What's more, many other health plans expect to roll out similar programs in the future. For example, Blue Cross Blue Shield of Michigan, which has 4.7 million members, will spend $30 million this year to help PCPs offer medical home-style services. The program should impact about 4,900 primary care physicians.

Government health organizations are playing with this concept too. In one example, a Medicaid-based medical home project under way in North Carolina saved about $162 million in 2006, 11 percent less than the state would have previously spent. And, of course, there's the Medicare medical home program, which has $100 million in funding.

To learn more about this trend:
- read this article from The New York Times

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CA insurers spent less than 85 percent of revenue on care

Anne Zieger — Mon, 14 Jul 2008 11:00:08 -0400

A new report by the California Medical Association concludes that nine of the state's major health plans spent less than 85 percent of their revenue on medical care for their beneficiaries, a level which would become law if the state legislature passes a bill the CMA supports.

The CMA's medical spending report, which addresses the fiscal year ending June 30, 2007, uses data collected by the state's Department of Managed Health Care. Spending ranged from a low of 69.4 percent for Great-West Healthcare of California, to publicly-owned L.A. Care Health Plan, which spent 97.1 percent of revenue on care. Cigna weighed in at 94.3 percent, while WellPoint-owned Blue Cross of California came in at 79 percent. Kaiser Foundation Health Plan had a medical loss ratio of 90.6 percent.

By the CMA's calculations, if all of these plans had spent 85 percent of their revenue on care that year, it would have resulted in $1 billion more to pay providers, with the majority ($933 million) coming from California's two Blue plans.

To learn more about the report:
- read this AMNews piece

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U.S. carriers expand health insurance businesses into China

Abby Christopher — Wed, 25 Jun 2008 12:00:43 -0400

Aetna has opened an office in Shanghai, where it hopes to expand its health insurance business. Other insurers such as CIGNA, UnitedHealth Group and WellPoint also have established roots in China, all with an aim to sell supplemental health insurance. "It's a real hotbed place for large U.S. multinational or multinational corporations [from other nations] to open or expand their offices," said Martha Temple, president of Aetna Global Benefits. As the U.S. economy--and as a result, the health insurance market--becomes increasingly unstable, U.S. carriers are looking for new ways to expand into other markets such as China.

For more information:
- read the full Hartford Courant story

NY Medicaid will stop paying for 'never events'

Fri, 06 Jun 2008 06:59:58 -0400

New York's Medicaid program has decided to stop reimbursing for avoidable hospital complications and medical errors it considers to be "never events." Starting in October, it won't pay for care related to 14 conditions, including wrong-site surgery; foreign objects left in the body; medication errors; blood incompatibility; contaminated drugs and patient disability from electric shock. Hospitals that want to receive Medicaid payments will have to prove that such conditions were present on admission to get paid for treating them. Meanwhile, the state expects to keep expanding this list.

To learn more about New York's decision:
- read this Modern Healthcare report (reg. req.)

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Using claims data for doctor ratings poses big problems

Fri, 23 May 2008 06:59:59 -0400

In theory, physician ratings and rankings aren't as scary as they used to be a few years ago.

With activists like New York Attorney General Andrew Cuomo helping to spark systematic changes in such programs, health plans aren't shooting from the hip as much as they were before. Not only do health plans have to "behave" in New York, they're taking the new standards with them to their entire commercial populations (such as Cigna, which brought in the NCQA to oversee its entire ranking system).

Not only that, it's looking like some big stakeholders are starting to agree on what they want to measure. According to a recent announcement from the oh-so-respectable Robert Wood Johnson Foundation, a group of leading stakeholders in provider rating including the Leapfrog Group, the National Business Coalition on Health, the AFL-CIO, the American Medical Association and America's Health Insurance Plans have all agreed on a "Patient Charter" that sets principles for measuring doctors' performance. That ought to help, right?

Still, not everybody's happy, despite the progress that's been made to date. For example, just consider the Massachusetts Medical Society, which is suing over rankings it says are capricious and actively defraud consumers. It's main beef is that the claims data health plans are using to rank its members just don't cut it.

And there, folks, is one of the most stubborn obstacles to straightening this mess out. Let's say that the industry's leaders all agree on what's fair and reasonable to measure clinically, and that they reach some grudging consensus that cost is an issue worth using as some form of ratings scale. Given the extraordinarily complex, flawed and cryptic puzzle that is claims data, it seems unlikely that anyone can use it to make fair deductions about physician performance on a granular level.

OK, I realize that some of you will blanch when you read that, but I have to tell you that the preponderance of what I've read and seen suggests that this is true--if for no other reason than that in attempting to do a good job and pay fairly, the system is breaking under its own weight. (If you think I'm way off base, please feel free to write and tell me so. Some of these folks might be first in line.)

Look, it seems pretty clear that some form of ranking will arrive at some point. But in the meantime, it just isn't going to work to force quality numbers onto a data set that arrives at the door broken. Maybe, when we have a fully-implemented electronic medical records universe out there, we can rethink the whole thing. For now, perhaps health plans can come up with some other way of motivating doctors to play ball? - Anne