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GIVE US YOUR FEEDBACK ON CIGNA'S 2011 REVISION OF THE BEHAVIORAL LEVEL OF CARE GUIDELINES
Cigna maintains Level of Care Guidelines for behavioral health utilization management decision-making. The Level of Care Guidelines help ensure that care provided is based on appropriate medical evidence or evidence-based practice and that it is consistent with current and validated Clinical Practice Guidelines for condition-specific management of illness. Even so, consideration is always given to the local availability of services and to individual needs, on a case by case basis, when applying the criteria.
Each year, Cigna reviews its behavioral Level of Care Guidelines to assess appropriateness for continued use. At least every two years, revisions are considered, based upon changes in related literature, research, and evidence-based community practices. Cigna monitors new developments in technology and application continuously, and may revise the Level of Care Guidelines at any time that an update is indicated. Annually, Cigna's behavioral care managers and physician reviewers are assessed to determine if they are applying the Level of Care Guidelines (LOCG) consistently. Training or other improvement actions are conducted as needed.
In 2010, a workgroup of physicians and behavioral health clinicians completed a major two-year cycle review of our Guidelines. The following is a summary of the changes that were made in response to the review:
Prior to final 2011 adoption for use, Cigna is soliciting feedback from psychiatrists, therapists and facilities on the revised Level of Care Guidelines. To encourage your feedback, we have posted them on our website: Level of Care Guidelines
OTHER CLINICAL SUPPORT TOOLS AND CLINICAL PRACTICE GUIDELINES
Please note that the following changes were made in 2010 to our website:
To support clinical excellence, clinical resources from the Center for Quality Assessment and Improvement in Mental Health have been added, with permission of the copyright holder. The STABLE toolkit provides assistance in the identification and management of Bipolar Disorder and is located for practitioner review within our screening tools: Clinical Screening Tools
And also in the professional resource toolkit at: Treating Behavioral Conditions
Additionally, for use by Primary Care Physicians (PCP), Cigna has adopted the Depression Guidelines and tools from the MacArthur Initiative, and a link to these resources can be found within the Depression practice guidelines for PCP: MacArthur Initiative on Depression & Primary Care
CLINICAL DEVELOPMENT FOR EXCELLENCE
Free continuing education credits are available to physicians and nurses completing this Medscape course accessible via the NIAAA website link below: Video Cases: Helping Patients Who Drink Too Much
Cigna encourages the open discussion of care and treatment options between professionals and facilities and the individuals we serve.
ENCOURAGING MEDICALLY APPROPRIATE CARE
In our philosophy and in the decisions of management and staff, Cigna's goal is to ensure the authorization of medically appropriate care. Staff and network professionals are compensated in a manner that is intended to promote, rather than deny, quality care and services for the individuals we serve. Cigna considers the quality and the appropriateness of care and service prior to awarding any bonuses or incentives.
MEDICAL MANAGEMENT PROGRAM GUIDE
Cigna's behavioral Medical Management Program is a comprehensive publication offering information, guidance, and resources for clinical professionals to effectively interface with Cigna in their clinical practice. The Medical Management Program is updated frequently. To ensure you have the most recent information, freely review, print, or download it here: Medical Management Program Guide
If you are interested in joining the Cigna Behavioral Network, please visit the “Providers” section of our website, cignabehavioral.com, for information on how to submit an application for network consideration.
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