Well Behaved — What it means

• Accreditations
• Provider Network
• Care Advocacy
• Service Metrics
• Behavioral-Medical-Pharmaceutical Integration

We’ve been accredited by the Utilization Review Accreditation Commission (URAC) since 1993. URAC establishes a range of quality standards for the health care industry. These standards ensure that appropriately trained clinical personnel conduct and oversee the utilization review process, that a reasonable and timely appeals process is in place, and that coverage decisions are based on valid clinical criteria.

Another accrediting organization, the National Committee for Quality Assurance (NCQA) has awarded National care center in Minneapolis, MN and our Chesapeake Regional Care Center in Lutherville, MD with Full Accreditation. The NCQA is an independent, non-profit organization dedicated to measuring quality health care. It accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas, and managed the evolution of HEDIS, the tool used by the nation’s health plans to measure and report on their performance.

Not all MBHOs gain accreditation from URAC or NCQA; in fact, both accreditations are completely voluntary, and only a select group – us included – are willing to voluntarily submit their organizations to such a rigorous and thorough process.

Not only is our provider network one of the nation’s largest (with nearly 60,000 independent psychiatrists, psychologists, clinical social workers, facilities and clinics) it’s also rigorously screened to meet the highest standards of clinical and professional performance.

We work closely with our provider network to develop innovative ways to reduce paperwork so they can do what they do best: provide care. With online claims filing, benefits information, drug formularies, and cross-training on behavioral health issues, we ensure that our providers are capable of handling not only the physical side of care, but also capable of coordinating and collaborating with our behavioral health and pharmaceutical professionals to maximize health care outcomes.

We were among the leaders in removing preauthorization for routine care. Today our members have no pre-authorization requirements for routine care issues. Moreover, a dedicated Care Management professional remains in contact with a member who has sought assistance throughout the entire process of care delivery. This ensures that the member not only has obtained the most appropriate care, but is satisfied with the outcome as well.

The yardstick by which all organizations are measured. From intake to issue resolution, from the first phone call to the last face-to-face counseling session, one thing is clear: our service metrics are what other MBHOs can only hope to meet. Our ability to rapidly help a member get the appropriate level of care that ensures the best possible outcome for both the member and the customer is cited across the nation as something to which other organizations should aspire.

The majority of member phone calls are answered in three rings or less, with most issues successfully resolved during the first call. We place no time quotas on incoming phone calls: if a phone call requires 30 minutes of attention, it gets it. Calls aren’t passed along in order for intake staff to meet arbitrary numbers for fielding phone calls. It’s a fundamental difference between others and us: we operate from Care Centers, not Call Centers.

Our record of implementation is flawless. Whether it’s for customers with less than 50 employees or multinational organizations with thousands of workers, each customer has a dedicated implementation team that lays the foundation for a successful program. This team works hard to get programs up and running effectively and efficiently from the outset.

Our proprietary software programs give our customers detailed data that helps clarify the utilization of services. This not only helps discover current or emerging healthcare issues in a workforce, it can be used to improve the prevention or recognition of a range of medical, behavioral, and pharmaceutical issues.

Integrating these three components of health care has long been a guiding principle for all CIGNA organizations. We have developed collaborative processes that help fulfill the promise of health care integration. By fostering the growth of closer relations between behavioral health professional, primary care physicians, and pharmacists, care for a particular illness is more effectively addressed, misdiagnoses avoided, and improper dosing or specification of medications is minimized.

Disease management combined with pharmaceutical management is an essential capability, especially with the annually rising cost of prescription drugs. Given the positive health impact drugs can have on chronic conditions such as high blood pressure and diabetes, it makes sense to promote their use based on clinically sound medical and behavioral treatment regimens. Additionally, appropriately prescribed medications can reduce productivity losses for some of the most common and expensive medical conditions, whereas inappropriately prescribed medications not only fail to address the underlying health issue, they can exacerbate it, while contributing to an organization’s overall health care expenses.