CIGNA trumpets lower costs, better prevention in CDHP
Do consumer-directed health plans (CDHP) educate members about healthcare finances, reduce costs, and result in better-quality care than traditional plans? Or do they merely move costs from the employer to the employee?
That debate remains at the heart of whether CDHPs will grow or become a failed attempt by managed care to control costs. CIGNA recently added its voice to the discussion.
Members in the organization’s CDHP, called CIGNA Choice Fund, cost less than those in PPOs and HMOs, use preventive care, comply with medication, and use the best medical practices, according to the CIGNA Choice Fund Experience Study that was released in January. The study reviewed medical claims for 440,000 CIGNA members, including 22,000 people with hypertension or diabetes.
The study found the following:
Critics of CDHPs have questioned whether the plans can affect costs in the long term and suggest that the savings realized after the initial switch to CDHPs are only temporary.
However, in this study, medical cost trend was lower for CIGNA Choice Fund, and the lower costs continued in subsequent years.
“I think that three years of studies are now backing up the fact that these plans not only reduce costs, but, while reducing costs, can maintain or reach higher clinical outcomes in quality and evidence-based care,” says Will Giaconia, vice president of CIGNA Choice Fund in Bloomfield, CT. “It’s beyond question at this point. There is always an industry debate around CDHPs and their impact. It’s really hard to say there is any question anymore.”
Integration is key
Creating a culture of consumerism goes beyond set-ting up high-deductible accounts with health savings options. CIGNA has learned from its experience since launching the Choice Fund plans on the heels of the creation of health reimbursement arrangements six years ago.
The insurer has integrated consumerism throughout the organization and offerings. Its member Web site allows members to check their account balances, monitor claims, and compare providers and pharmaceuticals on cost and quality. CIGNA states that about 55,000 members visit the Web site every day. Giving members access to tools and resources are important so they can make wiser decisions, Giaconia says. “The game now is about this idea of engaging the member holistically. That’s what it is at the end of the day,” he says.
Not long ago, CIGNA and its competitors created decision support tools but did not integrate them into their services. “They weren’t really working for consumers the way they should in an integrated way. What we have done at CIGNA is take that and integrate the individual consumer’s experience and make it feel more like the experience they would have in more truly consumer-driven industries,” Giaconia says.
Taking a cue from consumer industries, such as credit card companies, CIGNA tries to help members understand healthcare and healthcare finances. In addition to the Web site offerings, CIGNA sends quarterly statements, similar to credit card statements, to Choice Fund members. This allows members to understand their explanation of benefits and how their healthcare’s quality and cost affect their health savings account balance.
“Consumerism is about engaging the consumer 360 degrees,” Giaconia says. “It’s not just the CDHP plan design and the account balance—those are obviously very important—but it’s engaging the consumer and helping them take better care of their health using the broad array of CIGNA’s health advocacy tools.”
CIGNA has also integrated cost and quality information into other areas. For example, the most popular section of the company’s Web site is the provider directory. Rather than simply list doctors, their addresses, and their specialties, CIGNA added cost and quality information so members can make wiser decisions.
“You get a complete window into the complete episode of care,” Joe Mondy, CIGNA spokesperson, says about the revamped provider directory.
“This is a great example in terms of engaging the member at the right time,” Giaconia says. “What better time to engage a member with cost and quality tools than when they are looking for a specialist, for example? Not only is that a good opportunity tactically, because a tremendous amount of volume is through the provider directory, but it’s also the time a consumer is choosing a doctor. That is when they will want cost and quality tools.”
The insurer has a similar program on its pharmacy page that allows members to compare pharmacy costs. The program also suggests that members opt for generic rather than brand-name drugs. Giaconia says the emphasis on lowering costs helped influence lower prescription drug costs.
The study found that members in CIGNA Choice Fund plans cost 10% less than those in traditional plans in the area of pharmaceuticals, although medication usage was higher for those in the CDHP. (See Figure 9 at right.) In fact, generic usage was nearly 5% higher for CIGNA Choice Fund plans. (See Figure 10 at right.)
“Integrating that into individual consumer experience that is natural is exactly the kind of consumer innovation that is going to occur and where we think the game-changing difference will be in the coming years,” Giaconia says.
Health advisors help members
In addition to educational outreach and combining cost and quality information into offerings, CIGNA employs health advisors who help Choice Fund members make wiser healthcare decisions.
The health advisors, who are health and wellness professionals, discuss treatment options with members, including ones that would be less costly and less intensive but likely to have the same clinical outcome. They also understand the account-based plan and can make suggestions to members about their plans and the healthcare system.
Health risk assessments and predictive modeling identifies members who may benefit from communication with health advisors, wellness programs, and self-management programs. Health advisors reach out to members who are at risk to help them take control of their health.
Prevention lowers costs
The study found that chronic diseases, such as hypertension and diabetes, cost less for CDHP members than those with similar ailments in traditional plans. CIGNA officials state that these results point to better chronic disease management in the Choice Fund plans. (See Figure 11 at right.)
CIGNA found that preventive care visits for Choice Fund members were 8% greater when compared to traditional plans. Additionally, preventive care visits for renewal-year Choice Fund members were 15% greater. (See Figure 12 at right.) The medical cost trend reduction was also higher in the areas of hypertension and diabetes for Choice Fund members than it was for traditional plans.
In the evaluation of more than 300 evidence-based measures of healthcare quality, CIGNA found that services such as mammograms and physician visits for diabetics were consistent with those in traditional plans.
CDHP opponents say putting more costs onto individuals force them to delay care—especially preventive services—because they can’t afford them. Health insurers, such as CIGNA, have responded to that charge by offering free preventive services.
CIGNA communicates the importance of prevention through its outreach and lets members know what services are covered for free. “We know, obviously, when we get people to take better care of themselves through preventive care, it reduces costs through the long run,” Giaconia says.
CDHPs work in tough economy
CIGNA says the results from its study highlight that CDHPs are a valid option for employers that are looking to save money and offer better solutions to employees.
“In these tough economic times, it’s critical that we do what we can to cut medical costs without cutting care,” Jeffrey Kang, MD, chief medical officer at CIGNA in Bloomfield, said in a prepared statement. “Critics of consumer-driven health plans contend that people will sacrifice their health to save money, when in fact, our data show that account-based plans save money even as individuals receive the same or higher levels of care than those in traditional health plans.”