Managed Care - March 2009 - (Page 40) Cigna’s CDHP Study Bolsters Prevention Impressive savings and compliance rates seen for those enrolled in Choice Fund, the insurer’s consumer-directed plan active and informed consumers of the their health care in CDH plans thanks to a combination of incentives to improve quality and reduce costs, transparency information that helps individuals make new presidential administration and calls choices for cost efficiency and quality, and support for universal health coverage may finally to guide and validate their decisions — such as the stem the wave of benefit restructuring that use of health coaches. For example, even though prehas engulfed the managed care industry in recent ventive services are covered 100 percent, total medyears. After all, consumer-directed health plans ical cost is reduced because individuals will go inneed enrollees who are much more involved with network for those services. When dealing with a both their care and its financing. We might indeed chronic illness, they will use Cigna’s health coaches be entering the “What, me worry?” era of health and disease and case managers to navigate the coverage, with the way trillions of dollars are health care system and identify the best and being tossed around. more cost-efficient treatments.” Help remove costs Through the combination of health insurance, employer-paid account funds, and indiIf that’s the case, then Cigna’s big multiyear vidual out-of-pocket payments, the member study of the claims experience of nearly becomes more active and engaged, Cigna offi440,000 members may stand as a testament to a bygone age. On the other hand, why should Critics of CDHP cials say. When these three elements are in proper balance, people tend to elect CDHPs not universal coverage include a consumer- contend that directed care option? CDHP proponents argue people will sac- during their annual enrollment period as a way to moderate their health care costs withthat these plans help remove costs rather than rifice health to save money, out sacrificing care. simply shift them elsewhere, and health care says Jeffrey “What may surprise people is that these cost quality improves. By removing costs, CDHPs Kang, MD, make coverage more affordable and, as a result, Cigna’s CMO. A savings are achieved by CDH enrollees who are at the same time receiving comparable or perhaps more accessible for millions of people comparison of the company’s even higher levels of care than those enrolled without protection. CDHP with its If that theory holds up, then Cigna’s study other plans says in PPOs and HMOs,” says Kang. “We in fact did a deeper dive into the experience of the 22,000 would be evidence of what can be accom- otherwise. individuals who have either hypertension or plished in a CDHP. The “Cigna Choice Fund diabetes. Medical cost trend was substantially less Experience Study” compares the insurer’s CDHP for CDH enrollees with diabetes [20 percent less] product to its HMO and PPO plans. Choice Fund or hypertension [18 percent less] while maintainreduces costs while better steering consumers toing similar treatment regimens, suggesting that the ward preventive services by providing 100 percent lower cost trend is a result of better chronic disease coverage for those services. For other services, costs management.” are paid with employer-funded health accounts such as health savings accounts or health reimSteady improvement bursement arrangements. “This shows how the theory of consumerism in For example, Cigna’s study reviews claims for health care works in practice,” says Jeffrey Kang, compliance with more than 300 evidence-based MD, Cigna’s CMO. “It shows that people are more measures of health care quality and found that By Frank Diamond Managing Editor A 40 MANAGED CARE / MARCH 2009
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