The Practitioner Conection
Volume XXVI, 2nd Quarter

2007 KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

From offices in Maryland, Texas, California, CIGNA managed behavioral health benefits for a total of approximately 7,253,500 participants of contracted healthplan and CIGNA's Preferred Provider Organization business in 2007. Additionally, benefits for approximately 3,000,000 employees of numerous employers, EAP services, and a managed psychiatric disability product were administered. The effectiveness and efficiency of all Quality and Utilization Management activities are evaluated annually to identify improvements from actions taken, to identify barriers to success, and to establish future quality and service goals.

During the 2007 program year, CIGNA demonstrated national clinical improvements in measures for:
• Ambulatory appointments achieved within 7 and 30 days of inpatient psychiatric discharge,
• Treatment initiation and engagement rates for participants diagnosed with alcohol and other drug dependence, and for
• Rates of unplanned readmissions.

Service improvements were achieved for
• Telephonic average speed to answer, calls answered within 30 seconds, and abandonment rate,
• Average claims paid turnaround time, claims paid within 30 working days, and for
• Satisfaction and access for the culturally diverse. In 2007, as shared in other articles, CIGNA received the NCQA “Innovation in Multicultural Health Care” Award for its behavioral program for innovations in increasing access to behavioral health services for culturally and linguistically diverse members.

Key Program Findings
Appointment Access: CIGNA defines standards for access to care that include 80% access within ten days for Routine care (ECHO satisfaction survey rating by participants who accessed care), 90% access within 48 hours for Urgent care needs, and 100% seen within 6 hours for Emergent Non-Life Threatening care needs, the latter two measured through information system. Participant complaints concerning access are also reviewed.

In 2007, although no site reached the goal of 85% for Routine access, all sites except Dallas met the NCQA national average of 80%. In both 2006 and 2007, all sites exceeded the 90% goal for Urgent care. Only Glendale met the 100% goal for Emergent care. However, all sites achieved scores of 99.5% or higher. Access complaints from those using services most frequently cited appointment availability as the issue. Results were driven by a 49.5% expansion of the Intermediate Care Network for urgent response in 2006, and a 22.3% expansion in 2007 of the Crisis Stabilization Network used for emergent care response. Further, between 2006 and 2007, medication evaluation and management was improved by increasing the numbers of nurse practitioners by 3.6% and Psychiatrists by 2.5%.

Telephone Access: Data for 2006 and 2007 showed increases in both average speed of answer and abandonment rates from third quarter of 2006 to quarter one of 2007. Goals of 30 second speed of answer, less than 5% abandonment rate, and 70% of calls answered within timeframes were not consistently met. Improvement in both rates was seen from second to fourth quarter 2007, following interventions that increased staff and reduced barriers related to call handling, documentation, and misdirected calls.

Practitioner Geographical Availability: CIGNA strives to monitor and improve the geographic availability of behavioral health practitioners and facilities. Annually, the percentage of participants who have availability to behavioral practitioners and facilities within established distances is assessed. Measurement is from the zip code of the participant’s residence to the zip code of the practitioner’s location of practice. Performance goals had been exceeded in 2004, 2005, and 2006, however, recruitment efforts continue as an ongoing process to provide adequate availability for the membership.

Reducing Claims Payment Turnaround Time: By instituting staff productivity standards and by reducing delays due to requests for more information regarding registration and eligibility, statistically significant improvements were achieved in 10, 15, 30-day rates for claims payment, none of which were at goal in 2005.

Facilitating Cultural and Linguistic Match for Participants: To increase participant satisfaction with access to care and satisfaction with counseling and treatment, CIGNA has increased cultural diversity within the practitioner network. The performance goal to increase practitioner diversity representation by 50% over three years has been achieved. The Practitioner Self Introduction (PSI) allows cultural and linguistic information to be used by members in the selection of a service provider.

Ambulatory Follow-up within 7 and 30 Days of Inpatient Psychiatric Discharge: Statistically significant improvement was seen at the Chesapeake site, from 2006 to 2007 on the 7 day measure, and from 2005 to 2007 on the 30 day measure (0.05 level of significance). At a national level, CIGNA (non-PPO) has achieved statistically significant improvement (0.10 level) on the 7 day measure from both 2005 and 2006 to 2007. Results have been achieved through a focus on pre-discharge engagement activities, discharge planning that directly and meaningfully involves the participant, and consistent follow-up monitoring.

Reducing Unplanned Readmissions: Reducing unplanned readmissions within 30 days of discharge from inpatient discharge is an important clinical outcome. By stratifying cases based on severity ratings and assigning sufficiently suited care management strategies, CIGNA was able to reduce national and PPO readmission rates from 2006 to 2007 by a statistically significant degree (0.05 level). Goals were specific to each care management site, but the overall goal of 9.1 readmissions per 100 admissions was not met in 2007.

Initiation and Engagement for Alcohol & Other Drug Treatment: Using internally constructed measures that mimic the NCQA industry standard, rates at which participants with alcohol and other drug dependence initiate and engage in treatment were improved statistically significantly (0.05 level) in 2007. The pre-established goal was not met for either measure, but the improvement provides encouragement that future improvements may meet goal of 58% and 24% respectively. The national improvement was driven by the NCC, which demonstrated statistically significant improvement in both measures. Interventions included increased screening, robust discharge planning, outreach and the provision of tools for use by participants experiencing these conditions.

Other Featured Articles:

AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS

EAP SUBSTANCE ABUSE ASSESSMENT AND MANAGEMENT REFERRALS

PREVENTIVE HEALTH PROGRAMS

PROVIDER SATISFACTION SURVEY

CLAIM OFFSETTING PROCESS

GAPS IN CARE FOR BIPOLAR DISORDER

MEDICAL MANAGEMENT PROGRAM

Practitioner Connection Home | CIGNA Home | Legal Disclaimer

©2008 CIGNA