The Value of Connected Behavioral, Medical and Pharmacy Benefits

For the fourth year in a row, Cigna's Value of Integration study demonstrates that connecting medical, pharmacy and behavioral benefits increases customer engagement, supports the whole person and reduces total medical costs. The results leveraged methodology developed with KPMG in 2018, in a match-case control study that examined approximately 2.2 million customers over a 2-year period.  The study compared those who have integrated medical, pharmacy, and comprehensive behavioral vs. those who have medical and basic behavioral coverage.

“More than ever, employers are prioritizing whole person health and offering fully connected benefits, which are key to attracting and retaining talent,” said Matt Totterdale, Senior Vice President Cigna Pharmacy. “Cigna offers tools such as our Cigna One Guide® solution, which gives us access to real-time data, predictive analytics and a complete picture of an individual’s health. With this tool, we can put actionable information in the hands of health coaches, doctors, pharmacists, behavioral clinicians and other health care professionals to create personalized, coordinated interventions that enable better quality care, at the right time, in the setting that’s best for the customer.”

Increasing engagement, improving outcomes

Employers offering integrated medical, pharmacy, and behavioral health benefits continue to see meaningful improvements in customer engagement and outcomes as compared to those who carve-out benefits individually. In fact, customers in the 2019 study demonstrated 17% higher engagement* in health and well-being programs, including counseling for conditions like diabetes and heart disease, lifestyle or wellness coaching to help with weight management and smoking cessation, and personal case management for more complex conditions like rheumatoid arthritis or cancer.

The study also revealed that when benefits are triple-integrated with Cigna, the focus on body and mind results in a 32% lower mental health readmissions*, 18% fewer out-of-network behavioral claims*, 5% higher utilization of high-performing, in-network providers* and a 4% reduction in out-of-network claims. * This translates to savings for both the individual and their employer. 

Customer engagement of this kind is made possible through Cigna's connected care model and integrated, real-time data that reveals the full health picture of customers – allowing for meaningful, personalized interactions – in the right moment.  Predictive analytics leverage integrated data to help get ahead of a disease, eliminate gaps in care, make it easier to understand health care choices and drive intervention with customers and providers that guide their next best action.

For example, when customers are newly diagnosed with a chronic condition, Cigna proactively connects with their doctor to clarify care regimens, supports them to be adherent, provides cost-effective medication alternatives, if needed, screens for mental health needs, and identifies the best location for treatments.  Also when a customer reaches out to Cigna, clinical and service teams use that full picture of customer health to identify potential gaps and encourage coaching – looking across benefits and beyond just the initial reason for the call. This allows Cigna to fully wrap customers with care, recommend support tools and programs at the right time, when they need it most.

Lowering total medical costs

With integrated medical, pharmacy, and behavioral health benefits customers are more engaged in their health and more likely to stay in-network for their care, resulting in savings for them and their employer payers.  The 2019 study shows that, on average, employers saved $207 annually* for each covered individual and when the individuals has an identified health improvement opportunity – which is about 16% of the population -  total medical cost savings go up to ~$867PMPY. *

The opportunity for savings is even more substantial when evaluating particularly complex and costly conditions. Within oncology, for example, Cigna works behind the scenes with an integrated team of specialty care managers, oncology specialists, social workers, pharmacists and behavioral clinicians to coordinate care while making it simpler and more affordable. In the 2019 study, we see on average, those with fully integrated benefits showed savings of more than $11,679 for customers with an oncology diagnosis* and 24% lower oncology in-patient costs. *

“We mobilize across the continuum of care – eliminating gaps in care, getting ahead of disease, and driving interventions with customers and providers that guide their next best actions,” said Totterdale. “This ultimately makes it easier for customers to understand their health care choices and helps protect against surprise costs. Our integrated approach maximizes every opportunity to deliver a health care experience that is affordable, predictable and simple.”

We are proud that our analysis continues to prove the value of integration and customer engagement, and our clients are saving even more money than previous years.  Connected benefits are truly the key to us providing simplicity, holistic health, and savings for those we serve.

*Cigna 2019 book of business study of medical customers who have Cigna pharmacy + behavioral benefits vs. those with Cigna medical + basic behavioral. Individual client/customer results will vary and not guaranteed. Average annual per member per year (PMPY)

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