CIGNA’s Behavioral Operations
 19M members: 53% “carved-in,” 47% “carved-out”
 EAP/Work-Life, Behavioral Benefits Management, Health and
Wellness Services, Disease Management Programs
 Headquarters: Eden Prairie, MN
 65K Network Providers
 1100 Employees, 60% Clinicians
 +600 Employees in Health Coaching and Disease Management
(e.g. Nurses)
 Process 4M+ Behavioral Claims per Year
 4K+ Employer Accounts
Behavioral Benefit Designs in
CIGNA’s Book-of-Business
 96% of large/medium employers have EAPs; all have
MH/SA benefits
 20% of plans have no day/visit limits to MH/SA inpatient/
outpatient services (in network)
 70% of plans have MH/SA co-pays and co-insurance at
or better than medical
 Utilization comparison between parity/non-parity benefits
shows little variation
 Full parity across the book is projected to increase total
medical and behavioral cost by 0.25% (in network), 0.4%
(in and out of network).
How Are MH/SA Benefits
Managed at CIGNA?
 No prior authorization for outpatient
 Inpatient benefit “denials” <10% of cases (re-direct to
partial or outpatient)
 Pro-active care advocacy for specified critical conditions:
– ADD/ADHD
– Autism
– Bi-Polar
– Recurrent depression
– Eating disorders
– Substance abuse
– Near benefit exhaustion
– 25+ sessions/year
CIGNA Book-of-Business
Utilization:
 21 inpatient psych days/1000; Average LOS @ 5.4 days
 8.3 inpatient SA days/1000; Average LOS @ 5.9 days
 Flat inpatient trend over five years
 362 psych visits/1000;
 12 outpatient SA visits/1000;
 33% presentation increase from 2003 but visits/1000 flat (i.e.
more people entering treatment for shorter durations)
 1 out of 200 people who use MH/SA benefits exhaust their
annual or lifetime coverage each year
 SSRI costs approaching $4 pmpm
 Anti-depressants rank third in total Rx cost (behind lipids and
anti-ulcer)
 90% prescribed by PCPs
CIGNA’s Policy Position on
MH/SA
 We support actions that reduce social stigma, broaden access
to quality care, and prevent unnecessary costs in the health
care system.
 We support the integration of medical/behavioral clinical
interventions and case management, and support initiatives
that address the needs of consumers holistically.
 The cost impact of parity is immaterial in a managed care
setting, and parity benefits help reduce stigma and promote
integration.
 We support the current Senate version of parity because it
reduces the administrative complexity and unnecessary cost of
state-by-state variations in regulations.
 We support coverage of treatments supported by clear
scientific evidence.
 We support transparency of provider performance and
accountability for clinical outcomes.
 We support open, competitive markets for MH/SA services and
benefits management.