One potential advantage of integrated administration of medical, pharmacy and behavioral health benefits is the improvement of medical outcomes.
Benefits integration can provide a more complete picture of a member’s health situation and more personalized care for employees and families. Physicians often see only a portion of their patients’ health profiles, and integrated information can be a valuable tool in managing a patient’s condition.
Also, integrated benefits administration helps facilitate outreach and support to physicians and coordination with other medical management strategies, such as disease management.
Integrated programs take shape
One example of integrated benefits administration is CIGNA Pharmacy Management, which has implemented coordinated programs that help alert physicians to opportunities to improve care for patients and support them in addressing patient issues.
As a result of integrated benefits data and claims analysis, physicians are notified of patients identified as potentially being in high-risk categories. In a survey conducted during pilots of these programs, 64 percent of physicians said program outreach and support were helpful in improving care.
Benefits integration in action
An asthma program, introduced nationwide in February 2003, identifies members who demonstrate increased use of reliever medications (used to treat asthma attacks) without controller medications (used to prevent attacks).
Clinical studies indicate an increased risk of hospitalization when large amounts of reliever therapy are used without controller therapy. The objective is to reduce asthma-related emergency treatment situations by encouraging physicians to prescribe controller therapy as they deem medically appropriate.
Programs like this work the following way:
* A monthly claims analysis, incorporating integrated medical and medication history and claims data, is used to identify members who demonstrate increased use of reliever therapy without controller therapy.
* Program management provides the member’s physicians with the pharmacy and medical claims history that indicates the member may be at increased risk of hospitalization.
* For members with a history of asthma-related hospitalization, emergency room visits or previous identification by the program in the last three months, a clinical pharmacist will contact the physician to review the member’s clinical information.
As a result of the pilot program conducted in 2002, 48 percent of identified members with asthma added controller therapy, helping to improve treatment. Many physicians indicated the additional information about their patients’ medical and prescription history was helpful in providing care.
Does your company’s health plan use integrated benefits administration to identify specific opportunities for improved health outcomes? Helping to improve the health of employees should be a priority for both the health plan and employer, and benefits integration helps make it possible. Gregory C. Donnelly ([email protected]) is vice president, sales manager, sales division of Cigna HealthCare. CIGNA HealthCare is one of the nation’s leading providers of health-benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA HealthCare provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Donnelly at (216) 642-2573.
