LEADERS IN HEALTHCARE: CIGNA Execs – John Sorrow and Chuck Utterback

HOLLI W. HAYNIE

LEADERS IN HEALTHCARE: CIGNA Execs – John Sorrow and Chuck Utterback | provider/payer relations, healthcare costs, transparency, CIGNA HealthCare, quality measures

John Sorrow

In today's evolving healthcare climate which emphasizes cost control, quality measures and rating systems, it seems even harder now for physicians to focus on the priority of providing care. With these issues not going away, and this month being our Provider/ Payer relations issue, Memphis Medical News offered the payer side the opportunity to express their perspective. We talked with John Sorrow, president and general manager for CIGNA HealthCare of Tennessee and Chuck Utterback, director of contracting for CIGNA in Memphis about cost control, transparency, quality, and what insurance companies can do to make things simpler for providers.
  

How can providers and payers collaborate better to improve the healthcare industry?

Sorrow – We now have a powerful tool, for the last few months, a predictive modeling tool that allows us as a health plan to identify, with up to 83 percent accuracy, individuals that will have an acute healthcare event in the next 24 months if nothing else changes.
 
This is an example of what we build our company around. This is a collaborative partnership that we have with the University of Michigan Health Science Center.
 
We want to marry that info with traditional health plan information which allows members to have helpful information that will allow physicians to take action and avoid acute events.
 

The burden of cost is disproportionately placed on providers. What can payers do to reduce healthcare costs?

Sorrow – We're going to continue to look for ways to reimburse physicians differently than in the past. We are trying to develop a concept and reimbursement mechanism that will (give people incentive) to practice primary care while providing an efficient use of all the healthcare tools. Are we there right now? No, not today, but we are building programs to head down that path understanding that the gatekeeper concept is not one that is sustainable.
 
We're actively working to improve our technology that we have so we are more cost efficient – to get people the information they need to have care at the right place, at the right time, in the right setting, in a more cost efficient manner.
 
Utterback– We've recently rolled out CIGNA's Cost of Care Estimator. This allows physicians and hospitals to go to our web portal and accurately get a real-time, point-of-care estimate. It's very detailed and takes all the various factors into account which shows the physicians, who can then show the patient, what the estimated cost of a procedure or treatment will be. It's very simple. All providers (have to do is) put in the CPT codes, the patient and treatment info, and it very quickly puts out a cost-of-care estimate.
 

Will CIGNA develop incentive programs for buyers of healthcare and insurance to place more of the burden of cost on consumers?

Sorrow – We are trying to be a leader as it relates to consumer driven healthcare, and not just as a high-deductible plan. We hear often the pain a high-deductible plan causes hospitals and physicians. We are trying to market plans that are more cost neutral to informed consumers – i.e. are you eligible for a disease management program, are you a smoker, did you fill out a health-risk assessment?
 
We've developed the high-performance network, the CIGNA Care Network. We analyze the episode-of-care data that would allow for a physician to adjust for age, acuity, etc. Through plan design, people will choose it because there will be better benefits and cost savings. Larger employers are catching on to this.
 
We're going to see a continued trend toward that but the challenge that health plans have is activating the consumer to care, and then provide them with the tools and coaching and resources to improve their health.
 

Acknowledging that cost is not an effective measure of quality, what ideas do you have on developing universal standards of quality measurement?

Sorrow – Admittedly, we and other insurance companies out there have looked at things on a purely transactional basis. We would like to look at it from an episode-of-care standpoint. We do fundamentally believe that quality healthcare is more affordable.
 
(Quality measurement) is a dilemma and is a question that won't be solved until hospitals, physicians, healthcare plans and employers come to some level of agreement. There is certainly an opportunity in our industry to collaborate more and come up with more standardized measures around these things. (We intend) to look at (quality) not on a transactional basis, but on an all-inclusive basis.
 

What can payers do to make the claims and reimbursement process simpler and more efficient for doctors?

Utterback– We're continually trying to improve the transactional situation with physicians so they can work with us better. We piloted the Well-Informed program in Memphis (last year). Ultimately this program can help lower the cost of healthcare and improve quality because we're able to go through claims and pharmacy data in the system and identify those who are in disease states and confirm whether or not they're getting their prescriptions filled and diagnostic tests performed. If our system shows (a patient) has not filled a prescription, we send notice to the physician.
 

There is a big push for providers to be more transparent, yet it's more like a one-way street. Isn't it fair that payers should have to offer the same transparency?

Sorrow – There may be some perceptions out there about that. There has been some level of transparency around health plans in the past. The unfortunate thing for us is that people have not really looked at it that much and I think that goes to the lack of consumerism in our industry. We're the only health plan in Tennessee that has been certified by the NCQA over the last 15 years. We extend an awful lot of resources to allow people to come look under our hood for all the things we do. We submit our effectiveness-of-care measures, our clinical info, chart reviews, member and provider satisfactory scores. If there are additional things out there, we would welcome being a part of that.