CIGNA HEALTHCARE IMPROVES MEDICAL MANAGEMENT WITH SAS®

In the face of increasing demands for individual customer-level transparency and better medical management reporting, CIGNA HealthCare turned to SAS to generate detailed, accurate and quick reports. The powerful informatics engine has increased efficiency by 100 percent, as it takes less time and fewer resources to equip customers with the information they demand.

Healthcare informatics is much more than simply managing claims data – it is a catalyst for improving individuals' health and costs. A health service company's ability to process, analyze and act on data is vital to helping engage members to effectively and efficiently optimize their healthcare options.

This emerging environment calls for operational transparency, data consistency and the ability to customize business intelligence applications to suit the needs of business units and customers. By choosing SAS Enterprise BI Server, CIGNA HealthCare addressed the requirements for flexibility, versatility and scalability in its analytics software and reporting engine.

"SAS had the whole package,'' says Di Meng, Assistant Director, Employer Informatics.

Meet the customer
Based in Bloomfield, CT, CIGNA HealthCare is one of the largest health-service businesses in the United States and offers diverse medical benefit plans, behavioral health coverage, pharmacy benefits, standalone case and disease management, and other products and services that form the core of its health advocacy strategy. "CIGNA HealthCare" refers to various operating subsidiaries of CIGNA Corporation, including Connecticut General Life Insurance Company. Products and services are provided by such operating subsidiaries, and not by CIGNA Corporation.
 
The Clinical Insight & Employer unit is responsible for clients' financial and quality reporting and is also involved in implementing various medical management, acute oncology and disease management programs. Healthcare informatics has become a service increasingly separate yet complementary to IT functionality because of the breadth of disciplines that benefit from it and the degree of medical analytic leadership required. Informatics at CIGNA HealthCare serves various divisions and takes the lead on analytics.

Complex challenges
To improve customer service and enhance member health outcomes, CIGNA HealthCare is focused on providing timely, accurate, insightful analyses to satisfy customer requests and other internal information needs while educating members about healthcare options. This capability is critical in making it easier to analyze how successful existing health-benefit plans and services are at supporting improved outcomes, educating members and analyzing the impact of proposed changes to benefit plans. And solutions must be deployed quickly and easily to a variety of audiences.

Clients require precise reporting as to the effectiveness of their medical management programs and the associated returns on investment. These types of reports are complicated – some are short-term, some long-term, others self-reported from nontraditional sources and so on. Add to it the requirements of HIPAA regulations, and CIGNA needed a real-time reporting system.

Moreover, buy-ups – programs like lifestyle and disease management that are added to coverage to achieve and maintain favorable outcomes, encourage behavioral changes and pre-empt costly conditions – are assessed via SAS Analytics. Because these programs can play a significant role in reducing the total cost of care for chronic diseases, CIGNA HealthCare must ensure and demonstrate their performance to retain clients. Efforts to monitor health outcomes and model the impact of program changes on member retention are impossible without the proper intelligence and analytics architecture that SAS embodies.

It would also be impossible to do this analysis for the thousands of midmarket clients that CIGNA serves. "You might have 50 or 60 national accounts, but you'll have thousands in the middle market. At that level, you can't really manually do anything. SAS solutions provide an environment to automate the process,'' Meng says. "With SAS, one employee can deliver 7,000 to 8,000 reports to the midmarket. We could not offer reporting solutions for these programs to the midmarket without SAS.''
 
The programs help encourage employees to adopt healthy practices. Companies, who pay extra for the service, want to know throughout the year how many employees have enrolled and whether it is making a difference in reducing costly health interventions.

And for reports to large companies? "Our efficiency has improved by 100 percent,'' Meng says. "SAS serves as the data engine and a backbone of the total infrastructure. That makes it very easy. We use SAS to provide an intelligence platform for multichannel services to the users."

Better analytics and integration
With SAS, not only does CIGNA HealthCare gain decentralized reporting – which allows information to spread faster internally – but it also gains a member-specific view. That view allows CIGNA HealthCare to be more effective in its approaches. As a result, analytics are more accurate, detailed and robust. The company also notes that SAS software's integration with outside applications has allowed for more organized reporting. Time savings are considerable. Anyone can generate reports for his or her clients, including analysts, salespeople, account executives and managers. Having the right internal information helps CIGNA HealthCare build new programs, build new health solutions for employers and customize services offered to target groups.

In addition, SAS helps CIGNA HealthCare maintain confidentiality and security. SAS Enterprise BI Server allows the company to control and manage levels of access to various pieces of information and reporting as required by HIPAA and other regulatory requirements.

CIGNA HealthCare has been one of the pioneers in risk analyses of its population, particularly with the evolving capability in health risk assessments (HRAs). CIGNA HealthCare has contracted with a major university's health management research center for exclusive rights to the university's predictive risk model and analytics. In addition, CIGNA HealthCare will incorporate an online behavioral-modification coaching program linked to the online HRA responses. As part of that initiative, SAS software's powerful analytics and data integration capabilities are supporting member-level incentives and compliance reporting of HRA responses for all participating clients.

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