CIGNA HealthCare is expanding its program to analyze and address potential gaps, omissions and errors in health care in an ongoing effort to improve quality of care and lower costs for its members and their employers. When the expansion is complete on January 1, 2008, the CIGNA Well Informed program will be included as a standard service in all of CIGNA’s medical benefits plans.

Using clinical rules-based software together with CIGNA’s integrated medical, behavioral, pharmacy and lab documents, CIGNA will conduct ongoing analyses to identify potential gaps or omissions in care for all its medical members. notes will be examined to look for possible gaps in chronic disease management, care patterns, medication compliance, preventive care and patient safety. Conditions the program will target include, among others, coronary artery disease, hypertension, hyperlipidemia, depression and diabetes. When issues are identified, CIGNA will communicate with members and their physicians so that any essential adjustments to the member’s treatment plan can be made. CIGNA estimates that under the expanded program, improvement opportunities will be identified for approximately 10 to 12 percent of a population.

“Gaps in care can occur when society don’t follow their physician’s treatment advice or when they don’t receive care that chases accepted clinical standards and best practices,” said Jeffrey Kang, M.D., chief medical officer, CIGNA HealthCare. “When that happens, society may not experience the best possible health outcomes and their health can deteriorate, while both the risk of complications and cost of care can increase. We want to help our members and their physicians avoid these situations whenever possible.”

For example, according to an August 2007 report by the National Council on Patient info and Education, in developed countries like the U.S., medication adherence among patients with chronic conditions averages only 50 percent, and poor medication adherence has been estimated to cost approximately $177 billion annually in total direct and indirect medical costs.1

A recent study published in the New England

Journal of Medicine estimated that U.S. adults receive only about 55 percent of recommended health care services.2 A 1999 report of the Institute of Medicine estimated that preventable medical errors cost the U.S. approximately $17 billion each year; about half of expenditures for preventable medical errors are for direct health care costs.3

“Improving the quality of health care that our employees receive is critically fundamental to our goal of encouraging a healthy, productive workforce, and that new program will help us manufacture even more progress in that regard,” said Pamela Hymel, MD, MPH, Cisco Global Medical Director. “Quality improvement can additionally help to control health care costs for our company, which is urgent to our ability to be competitive in the global economy.”

When potential gaps such as untreated high blood pressure or high cholesterol or strange delays in ordering refills for maintenance medication are found, CIGNA will inform the physician and the member, and share data that can help the physician in assessing the situation and determining the best course of action.

“As a health care services company, we have the ability to consolidate and analyze a significant amount of data. Now we can share data with physicians that they may not otherwise have readily available, such as medications prescribed by different physicians,” explains Thom Stambaugh, vice president of clinical program development for CIGNA HealthCare. “that means that we can help a member and his or her clinical team have a more complete view of the member’s care and treatment, and we can use our clinical resources to share that data and any potential concerns with physicians and members.”

The CIGNA Well Informed Program adds to CIGNA HealthCare’s already extensive suite of health advocacy programs that inspire prevention and wellness, help members better manage chronic disease and assist members facing acute or catastrophic illness. For more data on CIGNA’s health and wellness programs, please visit here.

Original post by Mallows