OUR PARTNERSHIP FOR HEALTHIER GROWTH
PREPARED FOR
February 17, 2022
January 24, 2023
Today’s Presenters
Kelly Dill
SVP, National Accounts Existing Business
Strategic Account Executive
Jennifer Durand
Senior Medical Executive
Mark Netoskie, MD, MBA
Behavioral Clinical Strategy Team Lead
Gail Smith, MS, LMFT
VP, National Accounts Existing Business
Aaron Graves
Director of Service Solutions
Allison Lara
VP, Health Systems Division
Sarah Sweer
AVP, Contracting – Texas Markets
Tammy Vincent
Taking extraordinary action
in Extraordinary times.
strong foundation
hospital system expertise
local strategy
our commitment
We're with you every step of the way.
U.S. workforce is overwhelmed, overworked,
and the burnout rate is rising.
4.2 M
Americans left their jobs in October 2021
drop in workforce productivity in Q4 2021
5.2 %
of U.S. adults report suffering from anxiety and depression
41%
RECOGNIZING THE EMPLOYEE HEALTH CRISIS
61%
* The Physicians Foundation 2021 Physician Survey: COVID-19 Impact Edition: A Year Later August 4, 2021. ** American Hospital Association, AONL nurse leader survey shows well-being, staff shortages as significant challenges, Sep 08, 2021. ***2020 Cigna Resilience Index Report .
20%
82%
of physicians reported experiencing burnout in 2021, up from 40 percent in 2018.*
of nurse leaders plan to leave the profession.**
of health care workers feel stressed due to COVID-19.***
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
22%
of Texas Children's members have a behavioral health diagnosis
visited a Primary Care Provider or Specialist
63%
Top Conditions include: Reactive Stress, Depression, Anxiety
Your Population:
77.5%
utilized preventive care services
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 • Specialized 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 Health System Community
a proven track record of administering
YOUR CUSTOMIZED SIGNATURE 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
CUSTOMIZED SIGNATURE NETWORK
OUR TEAM APPROACH DELIVERS AN OPTIMAL PROVIDER EXPERIENCE
Client Specific Network Operations Team
Donna Aday Accounts Receivable Manager
Mary Raby-Grover Provider Experience Liaison
SOUTH TEXAS
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
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
SOUTH TEXAS AREA
OUR CONTINUED JOURNEY TO TOTAL POPULATION HEALTH
Click an arrow to learn more.
VIRTUAL CARE
X
Helping to support employees seek care that is convenient and cost-effective Layered MDLIVE virtual services to support members 24/7/365 100% virtual benefit through MDLIVE expanding to preventative, routine and behavioral care
MDLive to support YNHHS virtual in markets where YNHHS physicians are not licensed
MDLive steerage to YNHHS physicians
Virtual Care
Partner and build-out MDLive as a complement to YNHHS’s sophisticated virtual care strategy.
Next Generation Collaboration
Lead on sustainable, value-based arrangements Identify opportunities and partner to address ‘Test and Learn’ together
MEDICAL MANAGEMENT
Approach data in a thoughtful and meaningful way
2018 – 2022 5% CAGR achieved
$9.5M in annual plan savings for medical management programs
Affordability – 65.5% discount results 2021 with 98.5% network utilization
Proven results:
Develop an approach to promote NEMG directly to YNHHS employees
Collaboration and Clinical Operations
Drive utilization of YNHHS facilities
Aligned engagement and service team members to support client-specific needs
Two embedded onsite health coaches aligned to support members and align with well-being initiatives
Customized precertification steerage outreach process designed exclusively for YNHHS
Real Time Redirection
• • • •
Clinical Operations Alignment
HTR Essential Plus 2023
Data-guided proactive outreach and prioritization
Best-in-class care management (Aon Audit 2022)
Hospital Vertical: Premium Personal Health Team
Evolution of Care Management– eviCore
77% engagement for high-cost claimants
Because it’s needed now, more than ever – especially for health care workers.
RAPIDLY EXPANDING AND INVESTING IN BEHAVIORAL HEALTH
• Free mental health educational seminars and training
*Cigna unique provider data as of October 1, 2021 **Enhancement opportunity
of crisis calls come in after business hours
39%
increase in provider cultural specialties/ demographics over the past two years
46%
24/7/365 access to all services
Fast, flexible access to quality providers
Culturally competent referrals
network growth over the past three years
83%
Houston area: 4,559 providers,
97%
Austin area: 2,445 providers,
• Personalized coaching support**
• Virtual behavioral provider network, including Talk Space, Ginger & MDLIVE*
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
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 gets to work. We review the data and identify two health engagement opportunities.
Mary doesn't have to worry. Cigna offers a prediabetes coaching program and coverage for health screenings.
Both are at no cost. Mary is eager to find a provider and schedule her appointments.
Mary is at risk for diabetes and due for her mammogram.
We give her a call to help.
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 Texas Children’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, surprised that she may have to pay a portion of her mammogram.
Cigna 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
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 personal advocate connects with Mary and introduces her to more wellness programs for her and her family.
Mary meets with an Onsite Health Coach to understand her opportunities to better engage with her health.
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.
A healthier Texas Children's Hospital teammate
Find Care
Schedule
Earn Incentives
Follow-Up
Well-Being
Online
Mobile
Live Phone
In Person
Tier 1 Provider Search
24/7/365 Personal Advocate
Onsite Health Coaches
Cigna Health Coach & Personal Advocate
Welcome
Your Cigna Team:
Day One and Beyond
Let's continue our commitment to better health for all.
TEXAS CHILDREN'S
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
Provider Experience Liasion
The Cigna Team for Texas Children's
David Cordani President & CEO, Cigna
Kelly Dill SVP, National Accounts Existing Business
Tim Vessel General Manager, South Texas and Louisiana
Jennifer Durand Strategic Account Executive
Customer Experience
Provider Experience
Clinical and Wellness
Health System Division
Michael LaMaster Client Service Executive
Erika Trovillo Implementation Manager
Specialized call team with dedicated 800#
Pam Kelly VP, Health System Contracting and Strategy
Staci Tobolowsky Astrein, MCN, RD/LD Onsite Health Coach and Registered Dietitian
Ashley Miller Onsite Health Coach
Mark Netoskie, MD, MBA Cigna Medical Executive
Sarah Sweer VP, Health Systems Division
Paul Richards Informatics and Reporting Consultant
Communications support
Thought leadership
Analyze utilization patterns with a Social Determinants of Health index
Executive Leadership
Signature Network Administrator
Allison Hofmann National VP, Health Systems Division
Aaron Graves VP, National Accounts Existing Business
Dedicated Resource - streamline authorization process
Sharon Blackshire Stewart, CWPC, MHFA Senior Engagement Consultant
Jennifer Calzoncit Client Engagement Director
Brian Casstevens, MBA, BSN RN Nurse Executive, Central and South Texas
We’ll continue to listen and ask the right questions to meet your goals.
Enhanced member health care experience – and health
Expanded support and proactive review.
Quality-based outcomes
Are we helping providers deliver a quality visit, giving them the tools to make it possible?
Lower costs
Continued trend management and discount improvement while driving to tiered networks complemented with a comprehensive virtual network.
PARTNERSHIPS TODAY AND IN THE FUTURE
PROVEN RESULTS
WE KNOW YOU
Let’s keep going – growing – and innovating – together.
Commercial Employer Medicare Advantage
Virtual Care Cedar Pay
Advanced Analytics Go-to-market Pilots
HEALTHY EMPLOYEES.
Fueling our partnership for healthier growth.
HEALTHY SYSTEM.
HEALTHY COMMUNITY.
THANK YOU
Confidential, unpublished property of Cigna. Use and distribution limited solely to authorized personnel. © 2023 Cigna
FINANCIAL execution
strategic partnerships
go-to-market solutions
We KNOW you. And we're here to deliver.
*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.
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.
Both are at no cost. AND can earn Mary more rewards.
Here for you.
Not just some of the time.
100% of the time.
YOUR CONNECTED, DEDICATED TEAM
Accounts Receivable Manager: Chris Delaney Hospital Provider Experience Advisor: Karen O’Halloran
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 YNHHS
All built on our strong, national, seamless network, Open Access Plus (OAP).
Yale specific additional resource to supplement the existing Cigna Team
DEDICATED TEAM, WORKING TOGETHER
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
THE CIGNA EXPERIENCE FOR
YOUR
PROVIDERS
Welcome,
YALE NEW HAVEN HEALTH PROVIDERS
A partnership built on trust so that your practice never misses a beat.
