OUR PARTNERSHIP FOR HEALTHIER GROWTH
PREPARED FOR
March 29, 2023
DARTMOUTH
Today’s Presenters
Tiffany L. Pierce
New England, Market Medical Executive
Anne Slaughter
National Account Executive
Brian Pettinato
VP, Network Management
Anthony Cali
Director Client Service Solutions
Wendy MacDougall
VP, Hospital and Health Systems Division
Sarah Sweer
MA LPC MHSP Behavioral Clinical Strategist
Liz Gallus
Senior Informatics Consultant, Client Informatics
Danielle Stanzione
Senior New Business Manager
Taking extraordinary action
in Extraordinary times.
strong foundation
hospital system expertise
local strategy
our commitment
We're with you every step of the way.
flawless execution
SUPERIOR CUSTOMER SERVICE & PROVIDER EXPERIENCE
STRATEGIC PARTNERSHIP
We hear you. And we're here to deliver.
U.S. workforce is overwhelmed, overworked,
and the burnout rate is rising.
4.0 M
Americans leave their jobs every month
of U.S. workers report at least moderate levels of burnout
59%
of U.S. workers experienced at least one mental health challenge over the past year
84%
1. U.S. Bureau of Labor Statistics, Job Openings and Labor Turnover Survey. February 2023. 2. Aflac WorkForces, 2022-2023 Workplace Benefits Trends Report 3. Lyra Health, The State of Workforce Mental Health in 2022
3
1
2
RECOGNIZING THE EMPLOYEE HEALTH CRISIS
61%
*The Economist, The Employer Imperative: Driving US Economic Vitality Through a Healthy, Productive Workforce, 2021
20%
50%
of physicians reported experiencing burnout*
of health care workers report being diagnosed with clinical depression or anxiety**
of health care workers say their personal life suffers because of work**
HEALTHIER EMPLOYEES MEAN HEALTHIER GROWTH
greater productivity
45%
stronger employee morale and motivation
37%
greater retention and loyalty
Outcomes of a healthy workforce:*
YOUR NEW GROWTH PLAN
*The Physicians Foundation. "The Physicians Foundation 2021 Physician Survey: COVID-19 Impact Edition: A Year Later." **2022 Cigna Vitality Benchmark Research
Valuable connections
• Bi-annual forums for health systems • Ongoing webinar access • Open forum for information sharing among health systems
• Case studies and research • Pilot programs
Insights and innovation
• Dedicated health care vertical executive leadership team • Dedicated health system call center
• Digital tools catered to the specific needs of health systems • Analytics designed specifically for hospital clients
People and processes
Not just support. A whole support system.
Tap Into The Cigna HealthCARE System Community
CLAIM SCENARIO
Standard
Custom
1. Infusion therapy claim w/associated separate billables covered as episode of care w/tier 1 copay
2. Observation benefit processing protocols
3. Tier 1 physician in a tier 2 or OON facility
4. Domestic stay tier 2 services at tier 1 benefit level
5. Only 1 copay applies for ultrasound, when technical and professional bills received
6. Hospital based providers (ARPs) will be processed according to the benefit tier of the facility
7. Incorrect billable would trigger incorrect benefit level for RAP, in presence of tier 1 facility usage
8. Member sees a tier 1 provider, with associated lab billing, and provider sends outside of Tier 1 labs
9. No prior auth for-Non-Open Tier 1 MRIs, and prior auth for all tier 2 radiology services, and redirection to tier 1
10. Two copays billed for hospital admission through ER (ER copay + inpatient copays, deductible, coinsurance)
We're on it.
Claims Technology Built for Health Systems.
WELCOME TO
Your Client Specific Network
A well-built solution designed to help you maximize domestic utilization and drive preferred physician engagement.
Here’s how.
DEDICATED
Dedicated Team
Flexible and Capable Approach
Deep Experience
Both are at no cost. AND can earn Mary more rewards.
Mary doesn't have to worry. Cigna offers a prediabetes coaching program and coverage for health screenings.
Mary is at risk for diabetes and due for her mammogram.
We give her a call to help.
Here for you.
Designated team.
CUSTOMIZED SIGNATURE NETWORK
YOUR CONNECTED TEAM
Provider Relations Executive, Vickie Klecker Accounts Receivable Manager, Hyacinth Howard
Cigna/Yale Current Team Members:
Proactive roster management
Committed to all-things YNHHS Tier 1 network.
Client Specific Network Administration Coordinator
A high-touch concierge approach for physicians Proactive physician education and advocacy
Ensuring an all-around better experience for all
Provider Experience Liaison
Implementation, ongoing maintenance, and audits
Consultation and proactive issue resolution
Ongoing collaboration between Cigna and NSEEH
All built on our strong, national, seamless network, Open Access Plus (OAP).
Yale specific additional resource to supplement the existing Cigna Team
client specific NETWORK
OUR TEAM APPROACH DELIVERS AN OPTIMAL PROVIDER EXPERIENCE
Katie Hatala Client Specific Network Lead
Chris Delaney Accounts Receivable Manager
Client Specific Network Operations Manager
Rebecca Rutkowski Provider Relations Executive
Melissa Newton Accounts Receivable Manager
*The employer imperative: Driving US economic vitality through a healthy, productive workforce is an Economist Intelligence Unit report, commissioned by Cigna, that explores the role of employers in driving links between employee well-being and productivity, business success, and overall economic vitality in the US, particularly when considering the impacts of COVID-19.
PROVEN SUCCESS
7 unique CSN’s Complex management of multiple networks, fee schedules, and direct contracts with clinic physicians Dedicated support resource to assist with service, strategy, and maintenance
2 CSN’s, exclusive network, and complex fee schedule structures Cigna-initiated dedicated resource (BayCare liaison) to support a tightly managed client-specific (CSN) network.
7 CSN’s including both Medical and Behavioral Highly complex; multiple networks and custom fee schedules across various facilities
Multiple CSNs across 32 health systems Cigna dedicated network analyst and dedicated provider experience team
New Hampshire
Then & Now
Dashboard of opportunities - using advanced analytics to identify areas to improve quality and affordability with providers locally. Doubled the size of the network contracting team to better support the local providers. Almost every major delivery system in New Hampshire is engaged in a collaborative contract with Cigna and incentivized to improve quality and affordability. Every provider negotiation includes fixed pricing to give customers price certainty and price protection. Large and stable network of contracted providers in New Hampshire.
• • • • •
Information as of 1/31/2022. 1. Projected market discount improvement for New Hampshire FY2020-FY2023, based on specific targeted actions. Cigna’s Forward Looking Discount Process has been certified as meeting actuarial standards by an independent, third-party actuarial firm, Cambridge Advisory Group. The certification is issued based upon a review of all stages of the discount projection calculation, including but not limited to: provider contracts, provider specific rates and development by major service area (MSA) and service categories. Confidential, unpublished property of Cigna. Use and distribution limited solely to authorized personnel. © 2023 Cigna Healthcare
Philadelphia
Network COMMITMENT to
Dedicated local market organization and supporting infrastructure Talent Investment
• •
Hired leadership with extensive local knowledge of the insurer and provider landscape Doubled staff to increase presence
Long term affordable and predictable cost structure for clients and customers
•
Created value proposition based on aligned incentives Developed go to market strategy
Our continued journey to total population health
Virtual Care
X
MDLIVE steering to Dartmouth Health’s physicians MDLIVE to support non-office hours MDLIVE to support Dartmouth Health’s virtually in markets where Dartmouth Health physicians are not licensed
Enable all constituents to reach full potential
• • •
Medical Management
Work directly with the dedicated informatics team
Take a consultative approach ensuring utilization within Dartmouth Health
Collaborate and identify actionable areas to meet Dartmouth Health’s unique needs
ACO and HCC Optimization
Develop an approach specific to Dartmouth Health employees
Accountable Care Organization (ACO) and Hospital Collaborative Care (HCC) Optimization
Clinical Operations Alignment
Social Determinants of Health dashboard and analytical model
Attentive eye to simplify and streamline processes for Dartmouth Health
Hospital vertical “Customized Personal Health Team” alignment
Approach data in a thoughtful and meaningful way
Clinical Operational Relationship
Identify synergies within Dartmouth employees and ACO populations care management to optimize ACO/HCC performance
Reimbursement linked to outcomes
Aligning programs and processes
Partner and buildout MDLIVE as a complement to Dartmouth Health’s sophisticated care strategy including options for:
THE JOURNEY TO TOTAL POPULATION HEALTH.
Click an arrow to learn more.
Hospital Vertical “Customized Personal Health Team” alignment
Social Determinants of Health “Dashboard Risk Prediction” analytical model
Data-guided prioritization
Aligning programs & processes to clinical activity
ACO Optimization
Identify synergies within NSEEH employees and ACO populations Care management partnership to optimize ACO performance Partner with MDLIVE for after-hours virtual care opportunities
Real-time redirection
Customized precertification steerage outreach process designed exclusively for NSEEH
Prospective redirection process where intervention happens before the service or procedure occurs
Inform and educate about the highest quality service at the lowest cost
Drive utilization of NSEEH facilities
Real Time Redirection
MEDICAL MANAGEMENT
Work directly with the dedicated clinical informatics team
Take a consultative approach ensuring domestic utilization
Collaborate and identify actionable areas to develop design solutions
Develop an approach specifically for NSEEH employees
WHY THE PROVIDER COMMUNITY TRUSTS CIGNA
Strategic Partnership
Strong focus on bringing all constituents to the same table
Next-Generation Care Collaboration
Lead on sustainable, value-based arrangements
Identify opportunities and partner to address
'Test and Learn' together
Providers' Partner of Choice
Reduce administrative burden
Partner to identify and address service opportunities
Athena Health Survey
Collaboration, not competition
Partner to help customers get the right care in the right place at the right time
Promote open-architecture network approach
60% of Chicago area membership engaged with a provider in a collaborative relationship
Collaboration, not Competition
Because it’s needed now, more than ever – especially for health care workers.
RAPIDLY EXPANDING AND INVESTING IN BEHAVIORAL HEALTH
24/7/365 access to customer service and crisis triage support Fast, flexible access to quality providers Culturally competent referrals Virtual behavioral provider network, including Talkspace, Ginger & MDLIVE* Personalized coaching support Free mental health educational seminars and training
*Cigna unique provider data as of October 1, 2021
Hospital Vertical “Customized Personal Health Team” Alignment
Social Determinants of Health “Dashboard Risk Prediction” Analytical Model
Data Guided Prioritization
Aligning Programs & Processes to Clinical Activity
Symbiotic Clinical Relationship Open and Regular Communication Reimbursement Linked to Outcomes
The 2nd component of “Network”
Customized precertification steerage outreach process
Drive utilization of DVACO facilities
A DAY IN THE LIFE OF
MARY
Welcome to Cigna,
Let’s get your health plan up and running, so your health care doesn’t miss a beat.
Get started
1/1
Today
You added your ID card to your Wallet.
Take your online health assessment – it’s quick and easy and can help guide you to better health. Bonus: It can earn you rewards too.
Friendly reminder:
Mary completes her online health assessment, and Cigna Healthcare gets to work. We review the data and identify two health engagement opportunities.
Mary doesn't have to worry. Cigna Healthcare offers a prediabetes coaching program and coverage for health screenings.
8pm
Mary needs to schedule her mammogram but isn't sure which provider to pick..
We listen.
Digital convenience is critical. But sometimes a real conversation with a real person is too.
Your YNHH Employee Hotline is open 24/7
myCigna.com makes it easy.
We guide.
We go beyond.
To help keep your health on track.
Convenience and cost are her top priorities. She needs a provider who fits within her schedule and her budget.
We point her to find the right care, educating her about Dartmouth’s high-quality care at the best cost.
Post-wellness screening
Right care. Right cost. Unexpected diagnosis code. –
This could lead to a series of phone calls to get it sorted out.
Mary doesn't have time for that.
After Mary’s wellness screening
A better experience.
Mary calls Cigna Healthcare, surprised that she may have to pay a portion of her mammogram.
Cigna Healthcare contacts the provider's office to discuss Mary's question and request resubmission with the updated claim code.
After just one call, Mary's claim is resolved.
Mary can reach us anytime – 24/7/365.
8:00 pm
Wellness program and rewards
Mary sees how easy it is to get care and earn incentives, and she wants to keep the momentum going.
Right care. Right costs. No homework.
Our Dedicated Onsite Service Coordinator connects with Mary and introduces her to more wellness programs for her and her family.
You’re eligible for our pre-diabetes coaching program. We are excited to talk with you about the benefits of this program and get you enrolled.
Even better news: It’s no cost to you AND it can earn you more incentives.
Dartmouth Health teammate
Find Care
Schedule
Earn Incentives
Follow-Up
Well-Being
Online
Mobile
Live Phone
In Person
Tier 1 Provider Search
24/7/365 Hotline
On-Site Service Coordinator
Cigna Health Coach
Welcome
Welcome,
NorthShore – Edward-Elmhurst Health PROVIDERS
A partnership built on trust so that your practice never misses a beat.
Your Cigna Healthcare Team:
Day One and Beyond
Let’s start out on the same page to write your healthy workforce story.
Dartmouth Health
Client Experience
Affordable
Predictable
Actionable Data
Consultative
Enhanced Member and Provider Experience
Simple
Cigna Team
High-Touch Approach
Informatics
Collaboration with Stakeholders
Meeting your needs through a proactive and local approach
Informatics Team
Assess wellness metrics vs goals and best-in-class targets
Understand domestic utilization and leakage patterns
Identify cost drivers and plan opportunities
Strategic Account Executive
Client Service Executive
Dedicated Full-Time Onsite Service Coordinator
Provider Experience Liasion
The Cigna Team for Dartmouth
David Cordani President & CEO, Cigna Corporation
Tiffany L. Peirce New England, Market Medical Executive
Kelly Dill SVP, National Accounts
Brian Pettinato National Account Executive
Customer Experience
Provider Experience
Clinical and Wellness
Health System Division
Jennifer Kacor Client Service Executive
Anna Gahm Dedicated Implementation Manager
One Full-Time Onsite Service Coordinator
Specialized call team with dedicated 800#
Provider Experience Liaison Rebecca Rutkowski
Accounts Receivable Manager Melissa Newton
Anthony Cali VP, Health System Contracting & Strategy
Alan Stricoff, DO FACP National Medical Director
Tiffany L. Pierce, MD Medical Executive, Midwest
Informatics & Reporting Consultant
Communications support
Real-time redirection support
Thought leadership
*Position will be fully dedicated to Yale New Haven Health
Analyze utilization patterns with a Social Determinants of Health index
Executive Leadership
Informatics Consultant
Allison Hofmann National VP, Health System Division
Sarah Sweer VP, Health System Division
Dedicated Implementation Manager
Anne Slaughter Senior New Business Manager
Kristin Jordal President, Midwest Market
Health Engagement Advisor
New England Nurse Executive
Behavioral Health Strategist
We’ll continue to listen and ask the right questions to meet your goals.
Enhanced member health care experience – and health
Are Cigna Healthcare’s support tools and resources working in concert with your tools?
Quality-based outcomes
Are we helping providers deliver a quality visit, giving them the tools at their fingertips to make it possible?
Lower costs
Are we driving more utilization of your facilities and preferred providers?
Let’s keep going – growing – and innovating – together.
Advanced Analytics Go-to-market Pilots
HEALTHY EMPLOYEES.
Fueling our partnership for healthier growth.
HEALTHY SYSTEM.
HEALTHY COMMUNITY.
THANK YOU
client experience
customer journey
provider community
network
support system
stats
cover page
What We’ve Accomplished
Where We Are Going
Established local market infrastructure and invested in talent Strong foundation of value based programs Executed on multi-year strategy to be market competitive
Industry leading trend Refinement and expansion of existing value based models Development of solutions specific to local market dynamics
Network Strategy
CHICAGO Area
THE CIGNA EXPERIENCE FOR
YOUR
PROVIDERS
