The 'New' CIGNA: Quality Program Strives to Get It Right the First Time

  Texas Medicine Logo

Medical Economics Feature - October 2006  

ByKen Ortolon
Senior Editor

It's called "Six Sigma," and CIGNA says it is helping change the way it does business to help physicians, itself, and its customers. If the process works, company officials have told Texas Medical Association leaders, it will reduce errors in its claims payment and other processes that affect physicians' practices.

Three years ago, the health insurer launched a continuous quality improvement program using the Six Sigma methodology borrowed from the manufacturing industry. The process aims to eliminate errors by systematically analyzing data to improve business operations and measure quality improvement.

"If it's successful, it should have a significant impact on physicians because CIGNA is using the process to improve its provider relations, whether it's how long office staff are on hold when calling CIGNA, how long it takes to get a claim processed, or how long it takes to get a denied claim appealed and reprocessed," said Wichita Falls pathologist Susan M. Strate, MD, chair of TMA's Council on Socioeconomics. "All of those parameters should be a part of what is being addressed by CIGNA."

Early results are encouraging, though not everyone is happy with the "new" CIGNA. 

Reducing Variation

Six Sigma methodology gets its name from the symbol statisticians use to represent the standard deviation from the mean in a set of data. When discussing error rates, achieving six sigma, or six standard deviations from the mean, means you've virtually eliminated all errors from a process.

CIGNA committed to implementing the methodology in 2002 when it recruited Leslie Behnke away from Motorola, Inc., one of the trailblazers in using Six Sigma, to lead its effort.

Ms. Behnke, CIGNA's vice president for Six Sigma business excellence, launched rigorous employee training throughout the company, including top corporate executives, to carry out quality improvement initiatives in virtually every part of the business. CIGNA launched its first Six Sigma project in mid-2003, and in January 2004 the company began implementing Six Sigma projects within its Provider Network Operations Group. Since then, 15 quality improvement teams have helped improve processes relating to physician credentialing, hospital contracting, and other provider-related operations.

CIGNA found, for instance, that it was not quickly and accurately loading into its computer system contract data for new hospitals joining its network. That meant it was not paying claims as quickly as it could be.

Four different CIGNA offices around the country processed contract data; each had a different process. The Six Sigma project reduced the time to load contract data by more than 50 percent - and cut payment delays - by standardizing the data-loading process and measuring how long it took and how accurately it was done, Ms. Behnke says.

CIGNA is working on another Six Sigma project that Ms. Behnke hopes will speed up credentialing of new physicians in its network. And, the company is maintaining an ongoing dialogue by surveying physicians who have contacted their call centers with claims-payment or other issues. The surveys measure physician satisfaction with how their issue was handled and let doctors tell CIGNA how it can improve operations, she says. 

Finding Value

According to iSixSigma Magazine (at  www.isixsigma-magazine.com), a publication devoted to the quality improvement methodology, U.S. companies who have implemented such projects over the past decade have saved billions of dollars. CIGNA officials say they hope to save money and staff time, as well, by reducing the number of claims that have to be reworked because they weren't paid properly the first time. But they also say Six Sigma improvements will boost both their customer retention and provider satisfaction levels.

Ms. Behnke says the physician surveys indicate CIGNA is doing a better job in claims-payment and other physician relation issues. Dr. Strate says TMA also can measure the impact of the quality improvement projects by tracking complaints submitted to TMA's Hassle Factor Log.

So far, those complaints seem to be declining. Physician complaints about CIGNA spiked from 41 in 2002 to 283 in 2003, but have since trended downward. There were 80 CIGNA hassles reported to the Hassle Factor Log in 2004, 73 in 2005, and only 20 through the first seven months of 2006. Also, CIGNA ranked well recently in the log's number of complaints per physician in its network, compared with other major health plans.

Even so, some physicians are still seeing problems in CIGNA's operations.

Houston ophthalmologist Charles Soparkar, MD, performs plastic surgery procedures around the eye. He says he consistently has problems with CIGNA's benefit determination process for those procedures. CIGNA routinely refuses to tell him if a patient's policy covers a particular procedure without a full medical review, even when he later learns the policy clearly excludes the procedure, he says.

Mary Randall, practice manager for Beaumont obstetrician-gynecologist Khalid Kayani, MD, also says she's seen no improvement in CIGNA's claims-payment practices.

"When they want to pay, they're   wonderful," she said, "but when they don't, they're horrible."

Dr. Strate says TMA will continue to monitor CIGNA's quality improvement efforts through the Hassle Factor Log program and its ongoing meetings with the carrier.

Ken Ortoloncan be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at  Ken Ortolon.  

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