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CIGNA HealthCare Chief Medical Officer Says Health Care Delivery System At "Crossroads"; Must Improve Value To Consumers

Published: Oct 03, 2005

BLOOMFIELD, Conn., Oct. 3, 2005 /PRNewswire-FirstCall/ -- Managing costs alone is no longer enough for health care consumers or the employers who provide their health care benefits, according to Jeffrey Kang, MD, chief medical officer of CIGNA HealthCare. Speaking at the 10th annual Disease Management Congress, held September 21-23 in Orlando, FL, Dr. Kang said improving the overall quality of health care "is critical to our health and well-being as a country and as a society."

"This is not a 'nice-to-do,' it's a 'must-do,'" Dr. Kang said. "Americans pay a lot for health care, and too many of us aren't getting our money's worth. Statistics show wide variations in quality of care and delivery across geographic, racial and ethnic lines, as well as among plans and providers."

Citing the National Committee for Quality Assurance's (NCQA) 2005 State of Health Care Quality Report, Dr. Kang noted that the health care system's routine failure to provide needed care accounts for some 83 million avoidable sick days, equating to more than $13 billion in lost productivity.

"Poor quality hurts us all," Dr. Kang continued. "Not just the individuals who receive substandard care, but also the businesses whose productivity suffers when their employees don't get good health care. That, in turn, affects us as a nation, because our economic well-being stems from the productivity of the business sector. So I'm not overstating the case when I say improving the quality of health care is one of our nation's most critical issues."

The keys to quality

Dr. Kang said one way to improve America's health care quality is for plans and providers (doctors and hospitals) to embrace nationally uniform, evidence-based performance measures for clinical care and quality.

Dr. Kang noted that many in the industry - including CIGNA - have already taken significant steps in that direction, by adhering to measurement standards developed by accrediting organizations such as the NCQA and the National Quality Forum. Moreover, Kang said that beginning in 2006, CIGNA will become the first national health care plan to voluntarily begin measuring and reporting on health care quality for members in many PPO plans.

CIGNA also endorses and participates in coordinated measurement and reporting programs gauging provider quality and efficiency through industry- wide initiatives spearheaded by groups such as the Ambulatory Care Quality Alliance (AQA) and the Integrated Health Association in California.

In addition to promoting performance measurement of providers, CIGNA also supports performance measurement of clinical quality at the health plan level and has consistently recorded year-over-year improvement in its own HEDIS survey scores. In the HEDIS "Effectiveness of Care" category, for example, the company has posted an average improvement of nearly 16 percent in the period from 2002 to 2005. Dr. Kang said CIGNA's HEDIS survey scores over that period reflect the company's "deep commitment to quality" in developing and delivering effective health and wellness benefits programs.

"The HEDIS data are a guidepost all of us in the industry can use to allocate resources more effectively to better serve consumers," he said. "At the same time, making performance measures accessible to employers and consumers helps them select health plans and providers with proven records of quality. That saves money in the long run, by leading to better health care outcomes."

Dr. Kang said this data "transparency" is also critical to crafting effective pay-for-performance and benefit incentive programs, both of which can play a role in improving quality.

Pay for performance programs can facilitate meaningful competition, Dr. Kang explained. But, in order for them to work, every stakeholder must have access to accurate data about true costs and quality, based on uniform measures, packaged in a way they can utilize to make sound decisions about benefits and care. Toward that end, CIGNA provides quality and cost information to consumers and aggressively supports quality reporting and accountability initiatives fostered by advocacy organizations such as Bridges to Excellence, the Human Resources Policy Association and the Leapfrog Group, which include representatives from the private sector, as well as health insurers, health plan providers, physicians and hospitals.

Quality, and information about quality and effectiveness of care, will only become increasingly important as the industry shifts more toward consumer-focused health care plans, Dr. Kang said.

"Health care is at a crossroads, evolving toward a consumer-driven system. Studies show that consumers are willing to shoulder more of the costs for their health care. But, in return, they will also have higher expectations with regard to their own health and health care outcomes. Across the health care industry, we must substantially raise the bar for quality and results, if we're going to deliver the value consumers expect in return for taking more responsibility for their own care."

CIGNA HealthCare, headquartered in Bloomfield, CT, provides medical benefits plans, dental coverage, behavioral health coverage, pharmacy benefits, and products and services that integrate and analyze information to support consumerism and health advocacy. "CIGNA" and "CIGNA HealthCare" refers to various operating subsidiaries of CIGNA Corporation . Products and services are provided by these operating subsidiaries and not by CIGNA Corporation.

CIGNA HealthCare

CONTACT: Gwyn Dilday, CIGNA, +1-818-500-6370, gwyn.dilday@cigna.com

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