A CIGNA news release said the Care Network plans encourage workers to select a physician based on quality and/or efficiency measures. This plan design gives members the information they need to make informed decisions and then provides them with positive financial incentives to encourage them to seek quality care, the company said.
The new plans will be available in the following markets for plans effective January 1, 2006: Phoenix, DallasFort Worth, Houston, Miami, Orlando, Tampa, Richmond (Virginia), Greenville, Spartanburg and Columbia (South Carolina), Maine (all areas) and the metropolitan New Yorkarea, which includes northern New Jersey and Fairfield County, Connecticut. It will also be offered in Los Angeles and Orange County (California) for PPO and CIGNA HealthCare’s Open Access Plus products only beginning January 1, 2006.
The announcement said that the plans:
- allow members continued access to all contracted specialists in the network
- give members the choice to see any specialist they choose based on their benefit plan
- provide that co-insurance/payment level for members who want to see a non-CIGNA Care Network in-network physician remain at the standard in-network level established by their employer
- provide savings to members who see a CIGNA Care Network designated specialist through a lower co-payment or co-insurance level than the standard in-network level
“There is a strong link between the quality of health care a person receives and the resulting costs of that care,” said Jeffrey Kang, M.D., chief medical officer for CIGNA HealthCare, in the news release. “CIGNA Care Network designated specialists have demonstrated superior performance against key quality and efficiency measures that may lead to improved clinical outcomes and cost savings for consumers and employers.”
While benefit plans vary by employer, Kang said he expects most employers to establish a consumer cost-sharing difference of $10-$30 per office visit between the standard in-network co-payment or co-insurance amount and the highest level of benefits available for selecting a CIGNA Care Network specialist physician.
Physician evaluation includes 21 specialties accounting for approximately 95% of total specialty care and 60% of all medical/pharmaceutical spending.