• 13 May 2009

CIGNA HealthCare Addresses Price Transparency at the Point of Care

Innovative Cost Estimator takes the surprise out of healthcare payment

CIGNA HealthCare is one of the nation's largest health insurers, covering more than 12 million individuals. Through user-experience interviews with covered individuals, employers, and healthcare providers, CIGNA discovered that 21st-century benefit plan designs were creating a new set of challenges:

  • We were ill-equipped to handle more complex deductible- and coinsurance-based plan designs
  • Individuals were confused about how much they owed and surprised upon receiving their bill
  • Providers were spending large amounts of time trying to collect payment from patients
  • Provider bad debt was increasing at twice the rate of revenue growth

COURSE OF ACTION

CIGNA, seeing an opportunity to solve a pressing problem and improve satisfaction among both individuals and providers, evaluated a variety of approaches, from contract-based solutions to real-time adjudication. The company wanted a simple solution-one that met the market need and could be implemented without requiring major systems investment by CIGNA or its providers.

CIGNA worked collaboratively with Thomson Reuters to develop the CIGNA Cost of Care Estimator, based on the Thomson Reuters Treatment Cost Calculator. There are two components to the solution: Estimating the amount CIGNA will reimburse the provider and calculating what the patient owes. This estimate is then personalized by taking real-time information about the individual's benefits (e.g., remaining deductible, coinsurance, and co-payments) and applying it to the estimate.

RESULTS

In early 2008, CIGNA began a market trial with provider partners in eight markets. CIGNA was interested in evaluating both usability and accuracy, as well as clearly understanding the value of the solution to both providers and covered individuals. CIGNA also worked with Thomson Reuters to assess the accuracy of the estimates by matching them to claims and evaluating both the estimated allowed amount and the patient's liability. The findings revealed that 90 percent of the estimates were accurate within 10 percent of the cost. Patients reported that the estimates were helpful in explaining their financial responsibility and benefits in general, and made them more likely to pay their providers. The estimates were also beneficial to providers, who reported that they helped facilitate precare financial discussions with patients-improving the likelihood of payment.

Related Information

CIGNA HealthCare PDF