Cigna strives to make its claims data actionable for providers

By Leslie Small

As one of the country's largest health insurers, Cigna is well-versed in data-sharing initiatives with its network of providers. But with such a large of amount of claims data at its disposal, the key is to ensure the company presents that information in ways that make providers' jobs easier--not more complicated.

"One of our philosophies is to meet that provider where they are," Lynn Garbee (right), Cigna's senior director for value-based reimbursement and collaborative care, tells FierceHealthPayer.

That means adapting data delivery methods to suit providers' needs: Some want data in a "claims stream" that they can embed in their systems, while others want simple Excel reports that they can interpret on their own. "That's a challenge when working with more than 900,000 providers--meeting each one on their level," Garbee adds.

Cigna's primary focus is on delivering data that allows providers to manage patients in an actionable way by identifying gaps in care and interventions, she says. This not only helps providers manage their current patients, Garbee adds, but helps them acclimate to managing populations--a key component of value-based reimbursement models.

To guide quality improvement efforts, Cigna sends reports to providers that help them monitor quality and affordability by measuring them against their peer groups. Other reports help providers know when physicians move in and out of Cigna's network, or provide insight on the best specialists for patient referrals. 

Right now, the insurer is trying to get its provider partners comfortable with value-based reimbursement by starting with "upside-only" relationships, Garbee says. But in the future the insurer will take the training wheels off and move some providers to a higher risk model. 

Data, Garbee says, will be the key to making that transition--and guiding all forms of payer-provider collaboration.

"That's the foundation for all of these programs," she says. "It's about helping providers be successful with the patients that are aligned to them."

Cigna strives to make its claims data actionable for providers
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