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Cigna's Behavioral Operations serve 19 million members, offering a mix of "carved-in" (53%) and "carved-out" (47%) behavioral benefits, including Employee Assistance Programs (EAP), health coaching, and disease management. With a robust network of 65,000 providers and a team of 1,100 employees (60% clinicians), Cigna processes over 4 million behavioral claims annually. They prioritize care advocacy and support mental health and substance abuse treatments while maintaining strong parity standards. Cigna champions initiatives to reduce stigma and enhance access to quality healthcare, striving for holistic consumer solutions.
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CIGNA’s Behavioral Operations • 19M members: 53% “carved-in,” 47% “carved-out” • EAP/Work-Life, Behavioral Benefits Management, Health and Wellness Services, Disease Management Programs • Headquarters: Eden Prairie, MN • 65K Network Providers • 1100 Employees, 60% Clinicians • +600 Employees in Health Coaching and Disease Management (e.g. Nurses) • Process 4M+ Behavioral Claims per Year • 4K+ Employer Accounts
Behavioral Benefit Designs in CIGNA’s Book-of-Business • 96% of large/medium employers have EAPs; all have MH/SA benefits • 20% of plans have no day/visit limits to MH/SA inpatient/ outpatient services (in network) • 70% of plans have MH/SA co-pays and co-insurance at or better than medical • Utilization comparison between parity/non-parity benefits shows little variation • Full parity across the book is projected to increase total medical and behavioral cost by 0.25% (in network), 0.4% (in and out of network).
How Are MH/SA Benefits Managed at CIGNA? • No prior authorization for outpatient • Inpatient benefit “denials” <10% of cases (re-direct to partial or outpatient) • Pro-active care advocacy for specified critical conditions: • ADD/ADHD • Autism • Bi-Polar • Recurrent depression • Eating disorders • Substance abuse • Near benefit exhaustion • 25+ sessions/year
CIGNA Book-of-Business Utilization: • 21 inpatient psych days/1000; Average LOS @ 5.4 days • 8.3 inpatient SA days/1000; Average LOS @ 5.9 days • Flat inpatient trend over five years • 362 psych visits/1000; • 12 outpatient SA visits/1000; • 33% presentation increase from 2003 but visits/1000 flat (i.e. more people entering treatment for shorter durations) • 1 out of 200 people who use MH/SA benefits exhaust their annual or lifetime coverage each year • SSRI costs approaching $4 pmpm • Anti-depressants rank third in total Rx cost (behind lipids and anti-ulcer) • 90% prescribed by PCPs
CIGNA’s Policy Position on MH/SA • We support actions that reduce social stigma, broaden access to quality care, and prevent unnecessary costs in the health care system. • We support the integration of medical/behavioral clinical interventions and case management, and support initiatives that address the needs of consumers holistically. • The cost impact of parity is immaterial in a managed care setting, and parity benefits help reduce stigma and promote integration. • We support the current Senate version of parity because it reduces the administrative complexity and unnecessary cost of state-by-state variations in regulations. • We support coverage of treatments supported by clear scientific evidence. • We support transparency of provider performance and accountability for clinical outcomes. • We support open, competitive markets for MH/SA services and benefits management.
