Cigna to accelerate prior authorization and tie executive pay to member satisfaction


Photo: Jood Mind/Getty Images
Cigna Healthcare, the health benefits division of the Cigna Group, has begun a multi-year campaign to improve the experience for physicians and patients, in part by changing the prior authorization process.
Part of this effort includes adding new concierge teams to support customers experiencing challenges with prior authorization claims payments. A concierge will work directly with the customer’s physician to resolve any information gaps that require resolution, with the goal of helping to prevent stress or confusion for the customer.
Additionally, the company will introduce enhancements to the digital status tracker that patients can use for prior authorization updates.
Separately, Cigna floated a plan intended to increase access and affordability for its members, in part by tying executive compensation to customer satisfaction. The company will begin linking bonus awards for high-level officers to the its net promoter score
In addition to investing in more care advocates, the company will release an annual report, beginning next year, that will include information on business practices including prior authorization requests and appeals.
WHAT’S THE IMPACT
According to Cigna, one of the most common reasons that a prior authorization decision is delayed is because of incomplete information on the initial submission.
To that end, the company is expanding digital communication options for physicians, including through its provider portal or directly through the electronic medical record. This, said Cigna, will give physicians an easier way to submit all the necessary information the first time, improving turnaround time and accuracy.
Cigna is also changing its approach to advocates. To address patients with serious medical conditions that require navigating the world of clinicians, hospitals and pharmacies, Cigna Healthcare is doubling the number of My Personal Champion advocates, who help patients navigate through the various stages of their care process.
These advocates – who, according to Cigna, receive high ratings from customers – assist in the resolution of unique and complex clinical, situational or administrative needs.
“We are working to make it easier for customers to get the care they need and to resolve challenges faster when they arise,” said Bryan Holgerson, president, U.S. Employer, Cigna Healthcare.
THE LARGER TREND
The move by Cigna follows the shooting death of UnitedHealthcare CEO Brian Thompson last year, which prompted backlash against insurers. UnitedHealth Group CEO Andrew Witty addressed this backlash in a New York Times op-ed, saying the health system “does not work as well as it should” and calling it a “patchwork built over decades.”
The Cigna Group saw profits take a hit in the fourth quarter, reaching $1.4 billion, while it struggled with elevated medical costs, officials said during an earnings call last week.
Cigna’s profits for the year were $3.4 billion, a decrease from the $5.2 billion in profit logged in 2023. Chairman and CEO David Cordani said higher stop-loss medical costs were the primary factor in the company’s lower-than-expected performance.
The previously announced divestiture of the Company’s Medicare businesses to Health Care Service Corporation (HCSC) is expected to close in the first quarter of this year. There is no financing condition.
Last year Cigna entered into a definitive agreement to sell its Medicare Advantage, Supplemental Benefits, Medicare Part D and CareAllies businesses to HCSC for about $3.7 billion. As part of the transaction, Cigna and HCSC have agreed to enter into a four-year services agreement under which Evernorth will continue to provide pharmacy benefit services to the Medicare businesses when the transaction closes.
At the end of 2023, Cigna and Humana reportedly ended previous talks to merge after failing to agree on a price.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.