Most effective ways to promote health care accountability...Accountable Care Organization • Rewarded for NCQA Recognition • Rewarded for health outcomes • Accelerates improvement

Most effective ways to promote health care accountability:Two sides of the coin

Presented by:Wendy SherryVP of Product DevelopmentCigna

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

Traditional US care delivery model is flawed

Pays for volume –not value

Focus onillness –not health

Care isfragmented – not coordinated

No incentives to stop wasteful spending and improve patient outcomes

Minimal emphasis on stopping disease productionand keeping people healthy

Limited ability to share information, collaborate and consult = missed opportunities

2Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

Transforming the care delivery marketplace:moving from volume to value

Passive

Active

Volume

Outcomes

Discounts

Balanced Value Proposition

Consumers

PPACA is accelerating the need to realign incentives


Unit Cost/ Discount

Model

Pay-for-Performance

Model

Health CareProfessionals

Carriers

Transforming the care delivery marketplace: A new paradigm

Accountability


Networks• Medical• Pharmacy• Behavioral

Transparencyand Selection

HealthAdvocacy

Analysis andReporting

Plans and Solutions

Networks Unit Cost

Transparencyand Selection

Health Advocacy

Analysis and ReportingPlans and Solutions

Limited Accountability

Realigning incentives and collaboration to drive improved outcomes: the two sides

Empowered with:• Plan design• Incentives • Cost and quality tools• Coaching and

wellness programs

Provided with:• Incentives for

improved outcomes• Shared actionable

information• Clinical

collaboration


ConsumersHealth CareProfessionals

Carriers

Patient-Centered Medical Home

Accountable CareOrganization

• Rewarded for NCQA Recognition

• Rewarded for health outcomes

• Accelerates improvement through collaboration

• Leverages Cigna’s health services solutions• Rewards for improving health outcomes

Evolution of new care delivery model

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna 6

3Cigna Collaborative Accountable Care

2

1

3

Clinical integration to drive engagement• Embedded care coordinator

Information to drive action• Patient-specific actionable information• Performance reports

Key advantages over traditional model


Incentives to drive value-based decisions

Improved Results

Cigna Collaborative Accountable Care

Collaborative, accountable care in action


Patient not engaged in health:

• Type 2 diabetes• Not taking meds as prescribed• Missed doctor appointments• Multiple diabetic complications

Deteriorating Health

Cigna and physician

• Proactive outreach• Learned reasons for non-

compliance: Money problems, embarrassment

• Given medication sample and switched to lower-cost generic

• Payment plan for late fees• Referred to social services

Improved healthLower cost

Higher satisfaction

Making it real


Why a change must happen for consumers


70%of disease ispreventable or reversible3

Nearly 73% of customers are confused about how our health care system works1

LOW ENGAGEMENT

HIGHRISK

HIGHCOST

LOW TRUST

45%are not gettingappropriate care2

1. Source: Deloitte 2009 Survey of Health Care Consumers: Key Findings, Strategic Implication2. Source: www.cdc.gov/nccdphp updated April 20083. Source: New England Journal of Medicine, March 2006

Only 37% of customers are interested in using online health tools1

Consumer-focused solution


“I understand and see the value of

my plan. I want to participate.”

Optimal program design & ongoing

education

“Your help lets me reach my

goals.”

Revolutionized customer

experience

“I want quality care at the right

price.”

Easy-to-use cost and quality tools

“I want to achieve my best health.”

Personalized health support

A holistic approach to drive better health and health spending


Satisfaction and savings

Health and spending habits

Behaviors –not cost

The right mix to get it right

Deliver

ImproveShift

Create personal accountability to improve health and health spending choices


Passive Participant

“It’s not my responsibility.”

“I own it.”

Accountable Consumer

“I want to manage it.”

Active Participant

Create “Ownership” Mentality

8%-10% increase in use of preventive care40% more register online to use information and tools to make health care decisions

Strategies and tools designed to drive accountability


Clear & ContinuousCommunications

Plan Design

Cost & QualityTransparency

Incentives

IntegratedCoverage

INSURANCEJARGON

Best practice plan design that promotes quality careand delivers lower costs

Focusing health improvement efforts across the entire health spectrum


Passive Participant


“I own it.”



Active Participant

Change Behaviors

5x more likely to complete a health assessment19% more work with a health advocate21% more participate in disease management

Outcome-based incentive programs to improve level of engagement


Integrated with health advocacy programs

Target efforts across entire health spectrum

Customizable to meet unique needs

Active and ongoingengagement

Clinical improvements

Sustainable behavior change

+ +

2 to 4 times more take action = better health, lower cost

Revolutionized consumer-friendly approach to health care


Passive Participant


“I own it.”



Active Participant

Drive Empowerment

72% of individuals eligible for case management services engage with a coach 23% reduction in hospital readmissions

Access to information and support wherever, whenever

Year-to-dateexpense tracking

Up-frontcost quotes

Online and mobile service

Year-roundeducation

Easy-to-understand

receipts

24/7/365live service

Enrollment


Year-round communications for promoting engagement and accountability

Maintenance


ReinforcementEducationAwarenessPlanning

Choose the right plan

design and solutions

Develop leadership advocates

Use pre-enrollment to engage

and educate

Provide decision

support and resources year-round

Encourage health and well-being

improvements

The new paradigm

Consumer Accountability & Engagement

Sustainable:Improved healthAffordabilitySatisfaction

Health Care Professional Accountability


+ =

““Cigna” is a registered service mark and the “Tree of Life” logo is a service mark of Cigna Intellectual Property, Inc., licensed for use byCigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models are used for illustrative purposes only.

850432 09/11 © 2011 Cigna Some content provided under license.

Documents

Most effective ways to promote health care accountability...Accountable Care Organization • Rewarded for NCQA Recognition • Rewarded for health outcomes • Accelerates improvement