Cigna Healthspring: A Case Study

The Healthcare Industry and Its Constant Changes
Working in provider relations for Cigna Healthspring has been both very rewarding and challenging. Each year, the goal is to meet the standards set by the Centers for Medicare and Medicaid Services (CMS), while maintaining low medical cost. This seems like a rather simple concept in theory, but with an aging population achieving this is complex. Cigna HealthSprings vision statement is, “Revolutionizing the healthcare experience for our consumers by empowering providers.” This vision brought the company early success by implementing administrative principles to partner with providers using a preventative care approach to healthcare.
Cigna HealthSpring was one of the first Medicare Advantage plans
to use the preventative care model, and they could not do it alone. The model requires members to establish a relationship with a primary care physician (PCP) who will serve as the gatekeeper of their healthcare. The primary care provider plays a major role in preventative care and without them this model could not be achieved. Partnering, managing and maintaining relationships with physicians is critical to this model’s success so the company formed a team dedicated solely to this. This team is referred to as provider relations.
My first position in provider relations was an internal role, which meant most of my day-to-day assignments were completed in the office and required minimal interaction with physicians.
Earlier this year, I moved into an external role. I was excited but anxious about taking on a position responsible for creating synergy and strengthening relationships between providers and Cigna HealthSpring. This job is so important, so taking this position was intimidating at first. Learning the skills to communicate effectively with physicians and their office staff was the most challenging transition. Listening and interacting with different physicians is something that came easy. I enjoy hearing the provider’s thoughts about new and existing policies and their ideas on how we can improve them. Their input is invaluable to helping us come up with improvements to our processes. I have learned a lot about healthcare in general while building these
relationships.
The biggest challenge that I have faced since I took the external role is introducing and helping implement our new online portal to providers. Understandably, change is not always positively received at first so there were some providers that had their doubts about the new program. At first the general perception of the portal was that it was just another login and another barrier between them and their patients. Before rolling out the new program, we expected that there would be issues that would have to be addressed. Unfortunately enhancing things has taken time, and the provider relations’ team as well as the providers’ patience has been tested. Over time these issues have been identified and are being resolved. After months of negotiating and face-to-face meetings most providers have adopted the portal and have implemented it into their daily workflow. This initiative made the transition into my new role very difficult, but it has given me numerous opportunities to work directly with the providers and gain their trust.
The Medicare Advantage industry is quite complicated given the overwhelming number of rules and regulations that must be taken into account. To keep up with CMS changing policies, distinguish ourselves from our competitors and provide quality care to our members; we have to be flexible and think creatively. The preventative care approach has been successful for Cigna HealthSpring. However, it is more demanding for the primary care physician, which means we must have complete “buy in” from them in order for this to be successful. In the beginning, we created high expectations from our providers by incentivizing them with cash bonuses. These generous bonuses are still expected despite CMS continuing to make it more difficult to profit.
Finding ways to decrease medical cost is always a priority, but we are now tasked with thinking of ways to motivate providers with incentives other than cash bonuses.
How do you motivate someone to do more for less? The internal goal is to create cost effective ways to decrease the PCPs workload and still receive the information required to meet CMS standards. Despite all of the recent changes, as a company we must stay true to our original vision and empower physicians by including them in big decisions. Not only are these providers our partners, but also their insight is a valuable resource.
Although working in healthcare management can be a demanding and sometimes overwhelming, I enjoy its fast pace and the challenges that it presents. In my short career, I have faced changes personally, in my company and in the healthcare industry. These changes have definitely laid the groundwork for my career in healthcare management. I am determined to come up with creative solutions that impact the healthcare industry in a positive
way.