Cigna HealthCare Improves Medical Management with SAS®

In the face of increasing demands for member-level transparency and better medical management reporting, CIGNA HealthCare turned to SAS for help in moving operations forward with greater speed and detail – and with more accurate analytics. The result: a powerful informatics engine with a potential for return on investment of up to 200 percent for CIGNA HealthCare, says Tamim Ahmed, Ph.D., CIGNA HealthCare’s Vice President of Informatics. 

“Today, healthcare informatics is much more than simply managing claims data – it is a catalyst for improving member health and their costs,” Ahmed says. “Our ability to process, analyze and act on data is vital to helping engage our 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 various needs of each department and the various business segments. By choosing SAS for business intelligence, CIGNA HealthCare addressed the requirements for flexibility, versatility and scalability in its analytics software and reporting engine. 

Meet the customer
Based in Bloomfield, CT, CIGNA HealthCare is one of the largest health-services businesses in the United States and offers diverse medical benefit plans, behavioral health coverage, pharmacy benefits, stand-alone 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. 

Ahmed’s 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. “It spans the whole analytics and reporting spectrum,” Ahmed says. 

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. 

“With the growing popularity of consumer-directed health plans, the dynamics of financial and health decisions have changed,” Ahmed explains.  “As members increasingly have more responsibility and accountability in their healthcare decision making, they need to know the quality of providers and their costs for treatments and procedures. 

“Now our clients also require precise reporting as to the effectiveness of their medical management programs and the resultant return on investment. This type of reporting is complicated – some are short-term, some long-term, others self-reported from non-traditional sources and so on. Add to it the requirements of HIPAA regulations and we have a reporting system that provides information to those on a need-to-know basis.” 

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 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, Ahmed says. 

SAS boosts retention
To accommodate changes in CIGNA HealthCare’s business needs, informatics required speed, high data quality and seamless integration. A decentralized reporting process simplified the dissemination of information among subsidiaries using SAS. 

“Retention is a big issue,” says Ahmed. “If you can’t report, you can’t retain, because clients are increasingly sensitive to costs of medical management initiatives.” 

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. Ahmed also notes that SAS’ integration with outside applications has improved for more organized reporting. 

“SAS’ integration with Microsoft Office applications makes the process easy,” Ahmed says. “Time savings are considerable. You can decentralize reporting. Anybody can generate reports for their clients, whether analysts, salespeople, account executives or management. Having the right internal information helps CIGNA HealthCare build new programs, build new health advocacy for employers and customize services offered to target groups.” 

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

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 capability linked to the online HRA responses. As part of that initiative, SAS’ powerful analytics and data integration capabilities will support member-level incentives and compliance reporting of HRA responses. 

Big benefits
Measuring return on investment in terms of efficiency gains, CIGNA HealthCare has seen an immediate 30 percent improvement – with value increasing even more over time. “In the long term, we could easily have 100 to 200 percent ROI,” Ahmed says. 

And he’s pleased that SAS is committed to continued improvements as a software provider. “SAS always has had strength in data management,” Ahmed says. “But SAS’ reporting has gotten even faster and stronger over the last couple of years. Because we no longer have to manage data on one platform and transfer it to another platform and then use different software for reporting, we have finally bridged the gap between data management and business intelligence. SAS helped us to get there.”

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