The Practitioner Conection
Volume XXX, 2nd Quarter

2008 KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

In 2008, CIGNA managed behavioral health benefits for 7,598,225 individuals of contracted healthplan and CIGNA PPO businesses, and for 2,920,653 employees of numerous employers. CIGNA also delivered EAP services, and pioneered the final implementation of On-Line Disease Management programs. To gain better efficiencies in 2008, the utilization management for CIGNA's PPO product was largely centralized to Dallas operations. Effectiveness and efficiency of all Quality and Utilization Management activities are evaluated annually to identify improvements, barriers to success, and to establish future goals.

During the 2008 program year, CIGNA demonstrated statistically significant improvements in the following national clinical measures:
• Treatment engagement rates for participants diagnosed with alcohol and other drug dependence (AOD). Results were driven through the use of intensive case management and intensive outpatient programs, by using behavioral management coaching, and a care management emphasis on persons most at risk for failure to engage. The percentage of individuals who had two additional AOD treatments within 30 days after initiating treatment has increased each year, for the past three years.

• Rates of unplanned readmissions within 30 days of discharge from inpatient care have declined each year for the past three years. CIGNA educates and engages hospitalized individuals in keeping follow-up appointments. Intensive Case Management is available once discharged. We partnered more extensively with our crisis intervention network and facilities. In facility meetings, each facility was informed of their unplanned readmission rate.

Statistically significant service improvements were achieved for: • Telephonic average speed of answer, calls answered within 30 seconds, and abandonment rate. Rates for all three measures met goals for 2008, and the rates improved each year for the past three years. CIGNA has created a culture of performance through staff feedback and discussion, standardized call handling with load-sharing for high call volume periods, and streamlined documentation.

• Average claims paid turnaround time, claims paid within 30 working days CIGNA sustained performance at 99% for 2008. Staff was increased by 25%, with more rapid reporting cycles for unpaid claims, and both system and process efficiencies were implemented.

Other Key Program Findings
Appointment Access: CIGNA's standards for access to care include 80% access within ten days for Routine care (ECHO satisfaction survey rating by individuals who accessed care), 90% access within 48 hours for Urgent care needs, and 100% access within 6 hours for Emergent Non-Life Threatening care needs. Complaints concerning access are also reviewed. Interventions have included:
• Expansion of our Intermediate Care Network by 49.5% in 2007 and by 33% in 2008 to improve access for urgent care.
• Expansion of our Crisis Stabilization Network by 22.3% in 2007 and by 12% in 2008 to improve access for emergent care.
• Increases in the number of psychiatrists and therapists who can do medication evaluation and management. The number of nurse professionals increased by 3.6% in 2007 and by 7.6% in 2008. Psychiatrists increased by 2.5% in 2007 and by 6.5% in 2008.
• Published articles in E-Brief and the National Practitioner Newsletter.

In 2008, the Routine Access goal of 85% was not met, but improved year over year to 78% overall. Our Urgent Access goal of 90% was exceeded in 2007 and 2008, and scored 98.5% overall in 2008. The Emergent Access goal of 100% was not met, although overall performance was 99.7%. We continue to monitor and respond to complaints in order to identify trends and new opportunities.

Geographical Availability: CIGNA strives to monitor and improve the geographic availability of behavioral health professionals and facilities. Annually, the percentage of individuals who have availability to behavioral treatment professionals and facilities within established distances is assessed from the individual's residence zip code to the zip code of the professional or facility location of practice. Performance goals were exceeded 2004 through 2008, but recruitment efforts continue to provide enhanced availability.

Facilitating Cultural and Linguistic Match for Individuals: To increase individual satisfaction with access to care and satisfaction with counseling and treatment, CIGNA has increased cultural diversity within the professional treatment network. The goal to increase diversity representation by 50% over three years was achieved in 2007, and growth of diversity continues in 2008. Provider Self Introduction (PSI) Web pages allow cultural and linguistic information to be used by individuals in the selection of a treatment professional. We encourage network professionals to use and update their PSI with personal and practice information regularly.

Overall Accomplishments:
In addition to achieving statistically significant improvements, accomplishments in our Utilization Management Program included the creation of a dedicated Fastcert (Inpatient Admission Precertification) and an authorization team that improved authorization efficiencies across all levels of care. Our Intensive Case Management Program was revised and expanded to emphasize more difficult clinical presentations, and the Care Advocacy Program evolved into the Gaps in Care program, shifting focus from improved access to excellence in care.

Continuing Opportunities in 2009
Continuing opportunities for improvement exist in rates for Ambulatory Follow-up within 7 and 30 Days of Inpatient Psychiatric Discharge, Antidepressant Medication Management, and we will continue to pioneer innovative approaches for Bipolar Disorder, Attention-Deficit/Hyperactivity Disorder, and preventive health. If you would like more information on any of our quality initiatives, or would like to provide feedback or suggestions to our Quality and Utilization Management Program, please contact your Professional Relations representative.

Other Featured Articles:

2008 TREATMENT RECORD REVIEWS

COULD YOUR RECORDS PASS AN EAP AUDIT?

EFFECTIVE COMMUNICATION SERVES APPROPRIATE AUTHORIZATION

MEDICATION NON-ADHERENCE IN SCHIZOPHRENIA

NEW MIXED SERVICES PROTOCOL

ENSURING ZIP CODE ACCURACY

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