CARE ADVOCACY

At CIGNA, Care Management is monitored through Regional Care Centers (RCCs) or at the National Care Center (NCC). We have created a streamlined system that targets specific clinical categories where intervention is needed. We apply our Care Advocacy Program philosophy to inpatient and outpatient case management and have reengineered our Care Management model to provide targeted, proactive interventions for outpatient and higher levels of care. Program features include:

Outpatient Treatment
• We require no preauthorization for routine outpatient care.
• It is consumer driven—participants can pick a network practitioner and self-refer.
• There is systematic clinical identification of participants with either complex illnesses or high risk factors, allowing care managers to intervene only when or where appropriate and effective.
• We do detailed benefit education and help participants navigate the healthcare system.
• We coordinate care by facilitating relationships between Primary Care Providers and the behavioral health treatment team.
• We advocate for our participants by helping them know which questions to ask and what to expect from treatment.
• We make information packets, articles, and evidence-based screening tools available to participants and practitioners.

The outpatient portion of our Care Advocacy Program includes targeted workflows that ensure treatment is evidence-based and consistently reviewed among Care Managers. Condition-specific interventions are based upon literature findings, research, and population studies led by our Clinical and Medical Operations leaders.

Facility-Based Treatment
The CIGNA approach to inpatient and other higher levels of treatment follows a similar targeted process, where adding advocacy and evidence-based interventions reinforces the importance of treatment goals and aftercare planning. As part of our Care Advocacy model, our clinical teams emphasize case management and member engagement, and facilitate practitioners’ use of evidence-based practices to reduce or mitigate the need for readmission.

Intensive Case Management Program (ICM)
High-risk cases, as identified by inpatient care managers and a treatment model based on Six Sigma methodology, are referred to our Intensive Care Case Management Program (ICM). ICM is a free, voluntary, and confidential service to participants who meet the selection criteria. Participants are invited to participate in the program via a direct telephone call from a Care Manager and can opt out, if desired. The ICM Case Manager maintains regular telephonic contact with the participant and treating practitioners and assists the participant in identifying community or other resources that may be helpful in the treatment process.

We Want To Hear From You
If you have topics you'd like to see addressed here please let us know. Contact us at NetworkDevelopment@cigna.com and we'll dig into them. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.