The Practitioner Connection
Volume XXIX, 1st Quarter

AMBULATORY FOLLOW UP AFTER INPATIENT DISCHARGE

Facility treatment may stabilize individuals with acute behavioral conditions, but timely and appropriate continued care is needed to maintain and extend improvement outside of the hospital. CIGNA takes a focused approach to managing the transition from inpatient to outpatient behavioral care. Performance is measured against industry benchmarks to determine if ambulatory follow-up appointments are being reasonably achieved for individuals discharged from a hospitalization. In 2008, CIGNA did not achieve established goals but has attempted many strategies over time to improve these rates. In 2009, CIGNA will continue to partner meaningfully and engage with behavioral facilities, treatment professionals, and hospitalized individuals in an effort to improve rates for timely follow up appointments after inpatient discharge.

THE RELATIONSHIP BETWEEN CLAIM SUBMISSION AND ENGAGEMENT OF PEOPLE IN CHEMICAL DEPENDENCY TREATMENT

Submitting claims in a prompt manner can improve the engagement of participants in chemical dependency treatment.

CIGNA EARNS FULL NCQA ACCREDITATION

At the end of 2008, all four of CIGNA’s behavioral health care centers nationwide earned “Full” accreditation from the National Committee for Quality Assurance (NCQA**). In the past, these centers were each evaluated and accredited separately. Now, for the first time, all of the centers have been evaluated and accredited simultaneously, in keeping with CIGNA’s status as a national behavioral health service organization. The accreditation is valid for three years.

COORDINATION OF CARE BETWEEN HEALTHCARE PROVIDERS

CIGNA promotes communication between Employee Assistance Program (EAP) providers, behavioral healthcare practitioners and Primary Care Physicians (PCPs) to effectively coordinate EAP and behavioral care with medical care. This communication serves as a foundation for collaborative professional relationships and offers members a holistic approach to care focused on improving overall physical and emotional health.

RECEIVING PAYMENT AT THE CORRECT ADDRESS AND CORRECT PAYEE INFORMATION

From time to time claim payments are sent to the incorrect address or issued to an incorrect payee. There are easy steps you can take to receive your claim payment quickly and accurately.

EVIDENCE BASED TREATMENT PLANNING

Choosing the most effective psychotherapy for a mental health condition to be treated or being treated as well as reassessing the effectiveness over time of the psychotherapy being used is an important part of an initial and ongoing treatment plan. Although not all psychotherapies have been part of research studies, many have been studied. These studies support the efficacy of using evidence based treatment modalities. However, despite having good data to support the effective psychotherapies, many of the evidence based treatments are still underutilized.

TELEPHONE AND APPOINTMENT ACCESS

Since 2006, CIGNA has taken several steps to improve telephonic responsiveness to callers. In 2007, staffing was increased, misdirected calls were decreased, and efficiency improved by streamlining documentation requirements. Improvement initiatives in 2008 included creation of dedicated teams for individual customer and for professional callers. Increased efficiencies were implemented based on recommendations of a six sigma study and a Kaizen evaluation. Opportunities exist in 2009 for continued improvement in the Percentage of Calls Answered within 30 seconds, and to better support individuals who might choose to use CIGNA's Web-based behavioral directory of contracted network professionals to access routine outpatient care independently. To improve access to care appointments, CIGNA has increased the size of its Crisis and Intermediate care network and the numbers of professionals who can evaluation for and prescribe medications, as well as encourage visibility for specialty and diversity in service delivery.

"CIGNA" and "CIGNA HealthCare" are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by operating subsidiaries of CIGNA Corporation.” Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, 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 plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In Virginia, HMO plans are offered by CIGNA HealthCare Mid-Atlantic, 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 Connecticut General Life Insurance Company.

808353 10/07 ©2009 CIGNA