The Practitioner Connection
Volume XXVIII, 4th Quarter

TWO NEW INITIATIVES

Cigna conducts periodic assessments to ensure a high level of service and quality for the individuals we serve. Preliminary indications from two related pilot programs, undertaken in early 2008, suggest we are simultaneously delivering better care outcomes for the people we serve, while increasing facility satisfaction with Cigna service. The Intensive Care Management program improves clinical outcomes by focusing attention on those with complex clinical needs. The Fast Certification program reduces unnecessary administrative burden from the utilization management process for inpatient admissions.

When individuals are admitted for inpatient care, based on a set of clinical criteria, Cigna now stratifies their needs by complexity and their risks associated with readmission. Involvement by Cigna's licensed behavioral care managers is similarly stratified, so that people with more complex clinical needs receive increased, appropriate focus. Once discharged from inpatient care, these individuals are enrolled in an Intensive Care Management outpatient program (ICM). In this way Cigna provides support where it will add the most clinical value. At the same time, those people whose conditions are less complex are now served more quickly, both during and after admission. Facilities are experiencing shorter turnaround times and faster admission decision-making for these people, who represent the majority of individuals the facilities serve. It is our hope that better service and increased facility satisfaction with the utilization management process may result.

Program Goals:

Intensive Care Management seeks to improve quality outcomes by reducing readmission rates and increasing compliance with ambulatory follow up appointments within 7 days after hospital discharge. Our care managers focus intensely on individuals with the most complex clinical needs. These 20% of people who readmit to inpatient care account for 30% of overall healthcare inpatient costs. All people who are admitted, regardless of product or benefit funding, are reviewed for possible inclusion in the Fast-Certification and the Intensive Care Management programs:

High-Risk Indicators included in decision-making are:
1. Suicidal ideation/plan with an inability to assure safety outside of the facility, or a suicide attempt within the past 72 hours
2. Current plan to harm someone else
3. Hallucinations, delusions, or other psychotic activity
4. Physical substance abuse withdrawal symptoms
5. Readmission within 90-days
6. Children under 12 years of age
7. A diagnosis of Eating Disorder
8. ECT
9. A current Length of Stay that is greater than 4 days
10. Partial Hospital Program / Residential Program needs

Outcome Metrics are monitored to determine the effectiveness of our ICM and Fast Certification program interventions. These metrics include:
• Median Length of Stay
• Readmissions per 100 within 30 days
• Ambulatory Follow Up 7 Day Appointment
• Appeals of care decisions
• Denials of care requests
• Customer/Facility Satisfaction

The Current Status of the Programs

These new programs began in May 2008 and will continue into 2009, with ongoing monitoring of metrics. Preliminary assessments of facility satisfaction indicate a positive trend. The metrics concerning improved clinical outcomes for complex needs also appear to indicate that we are achieving program goals. Additional information on outcomes and facility satisfaction will be shared as it becomes available.

Other Featured Articles:

ACCESS TO OUTPATIENT CARE

IDENTIFYING BORDERLINE PERSONALITY DISORDER

CIGNA MEDICARE ACCESS

EAP ASSISTANCE WITH WORKFORCE REDUCTIONS

INSURANCE IDENTIFICATION CARDS

REMINDERS

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