Cigna Health Insurance Articles & Resources

The Value of Value-added

Schaffer is a 12-year CIGNA veteran, having held leadership positions there in managed care operations, health plan operations and global healthcare strategy development, preceded by executive stints at Aetna Health Plans and Humana. Schaffer's new role as chief clinical officer is one of strategist and influencer--he has no operational responsibility--leading a team that develops CIGNA's clinical public policy to improve healthcare outcomes and assure patient safety.

As a strategist, part of Schaffer's attention is necessarily keyed to the investor community. "Investors are very interested in the value-added model," he says. "Our clients are large customers, and investors look to us for corporate leadership in development of effective consumer-directed products."

Employers, he says, are "moving toward defined levels of healthcare spending and want to transfer decision-making from the health plan to the enrollee. At CIGNA, we see ourselves adding value through providing information, direction toward specific services, coordination of care and, finally, assistance in improving patient safety."

It is value, Schaffer stresses, not cost-shaving or gatekeeping, that will determine market distinction for both health plans and providers. That which contributes to quality care and quality results will earn support from employers and investors alike, and will also be supported by consumers, who have already demonstrated an increased thirst for comparison tools and knowledge of quality outcomes.

Change of Mindset

The sea change in healthcare for this millennium, according to Schaffer, is intense focus on quality, and that's exactly why CIGNA has ended its love affair with proprietary clinical quality programs. "CIGNA has refused to embrace anything except national standards," he says, citing the Institute of Medicine standards and also praising the voluntary performance-reporting initiatives of the National Committee for Quality Assurance. "The expressed opinion of major medical and professional societies is that providers want national, standardized, evidence-based care, and those organizations want providers to be better compensated based on those standards."

Only a handful of national health plans exist, he says, "and most continue to use proprietary measures of quality. The days when a health plan can say, 'Our DM protocols are the best, and they are proprietary,' are gone. Physicians don't appreciate this," and it is, after all, a partnership of physician, patient and health plan that will produce favorable health outcomes.

Multifaceted Approach

At the membership level, "CIGNA's approach is to meet the informational needs of the consumer," says Schaffer, describing an internal reorganization of both human and technology resources "according to the medical state of the individual." Although CIGNA clinical teams concentrate heavily on the 15 percent of plan members who generate the majority of healthcare expenses, five distinct areas receive attention from the company's human resources and IT commitments.

Healthy members constitute the largest subset, as well as the subset primarily served by a diverse array of IT tools. Through its extensive member portal, CIGNA offers healthy members: health risk assessment (HRA) tools that they can print out and/or submit to CIGNA for overview; hospital comparison tools to use when inpatient admission is imminent (Editor's note: See "From Opaque to Crystal Clear," HMT, January 2004); a pharmacy advisor for information on medication regimens; an evaluation health score card so members can chart their own healthcare progress against objectives during the year; and an extensive online health library.

Next up are the "worried well," members who are essentially well but who exhibit risk factors that warrant attention. CIGNA addresses this group with a Personal Health Advisor product that Schaffer says matches "a dedicated team of nurses to a client company," along with availability of a 24-hour help line. While Advisor isn't an outreach-based product, each human advisor can access CIGNA's multiple databases to compile a clinically integrated patient portrait that supports individual counsel for each member.

Outreach is applied to tackling chronic diseases. Schaffer says that in terms of national priorities, "there are 20 disease states" identified by the Institute of Medicine, and "CIGNA has programs in 17 of those." But he stresses that CIGNA's objectives extend beyond the traditional disease management (DM) goals such as "keeping the diabetic patient out of the ER. We can identify patients through submitted HRAs, claims data and lab data. Our objective is to not only avoid acute problems, but more importantly, to optimize long-term care," such as protecting diabetics' renal functioning and eyesight for improved quality of life.

For the acutely ill, CIGNA case managers oversee and coordinate care. The company used to maintain 41 different medical management teams, but has since centralized its physicians and nurses into four locations to address 20 specific conditions that Schaffer says are less common than those typically identified in DM programs, but which are medically significant enough to warrant intervention.

Tying the clinical teams, their objectives and members together is CIGNA's clinical integration initiative, supported by clinician access to robust databases of medical, surgical, pharmacy, lab and behavior health information.

Under Schaffer's leadership, CIGNA has put teeth into its public commitment to serve plan members with vigorous information and intervention. Earlier this year, the company added components for 10 additional health risks--including osteoporosis, hepatitis C and fibromyalgia--to its DM roster, along with a specialized program targeting obesity. Its renowned behavioral health program in Minnesota operates five . care management centers and supports more than 52,000 independent behavioral health professionals.

All of it, says Schaffer, is designed to improve both quality of care and quality of life for CIGNA plan members. Of 180 million Americans covered by employer benefit plans, only 3 percent are currently enrolled in consumer-directed health plans, but Schaffer predicts that number will rise to 50 percent by 2020. CIGNA is ready for them.

Thumbnail Portrait W. Allen Schaffer, ., .

Current position:

Chief Clinical Officer, CIGNA HealthCare and Senior Vice President, Clinical Strategy and Health Policy Privacy Officer for CIGNA Healthcare. Joined CIGNA in 1993 as National Medical Director.

Previously:

Head, professional affairs and quality management, Aetna Health Plans. Executive, quality management and primary care delivery programs, Humana.

Medical degree:

1975, University of Washington; Seattle Recipient, Robert H. Williams Medical Research Award.

Residency:

Tulane Service of Charity Hospital, New Orleans. Baptist Memorial Hospital, Memphis, Tenn.

Faculty appointments (previous):

Dept. of Medicine, University of Connecticut School of Medicine.

Dept. of Medicine, University of Louisville School of Medicine.

Board appointments:

Jacobs Institute of Women's Health.

Bazelon Center for Mental Health Law.