Health is a whole-person experience. When coverage and benefits for medical, pharmacy, and mental health care are working in tandem, it means better health outcomes for people who need it most. This integration is widely embraced by health insurance providers and employers who provide coverage to their workers鈥� saving thousands of dollars for companies and employees in the process.
Earlier this year, Cigna released a study that showed triple integration of medical, pharmacy and behavioral benefits resulted in lower health care costs for employers and better patient outcomes. The found that employers saved at least $148 per member per year when they integrated medical, pharmacy and behavioral benefits for employees.
We sat down with Cigna鈥檚 Chief Pharmacy Officer Katy Wong to learn more about the study and what it means for employers, health insurance providers, and patient care.
Q: How was the study conducted?
The , performed independently by Aon, compared groups of individuals whose age, gender, health status, and condition match. The groups in the analysis differed only in terms of their medical, pharmacy, and behavioral health benefits coverage. Cigna then supplemented the study to identify additional cost-savings trends for employers.
The findings confirmed that whole-person health is inextricably linked to benefits structure, and that there is significant value in the triple integration of benefits. This is the sixth year we鈥檝e conducted the study yielding similar positive results.
Q: What were the results of the study?
We found a direct connection between integrated medical, pharmacy, and behavioral benefits and lower medical claims costs. We also found that engaging employees to participate in health improvement programs, such as Cigna's wellness coaching, could further bring down these costs. Employers who engaged employees in health improvement programs saved more than $1,400 per member per year, which is significant to an employer鈥檚 bottom line.
When evaluating specific high-cost conditions and therapies, we found even greater cost-savings opportunities. Our research showed that for employees taking specialty medications and enrolled in a triple-integrated health benefit cost their employers nearly $9,000 less than those who are using non-integrated benefits. For employees taking specialty drugs and who also have a depression diagnosis, the per-member-per-year cost savings totaled almost $17,500 for employers.
Triple integration of benefits is a huge driver of affordability and predictability for employers, and we hope this information sheds some light on the value it can bring to their employees and their organization鈥檚 bottom line.
Q: Why do costs go down with the integration of benefits?
Integrated benefits create more connection points with a patient, and it gives us the opportunity to manage the entire course of therapy better, offer alternative pathway options, and look at the entire regimen with a holistic view to improve health outcomes.
Let鈥檚 say there is an employee recently diagnosed with cancer. Through the use of the myCigna app, we can tell when a person is using their benefits more than normal, which alerts a Cigna case manager that a patient may need additional guidance or support. This case manager can steer the patient to in-network providers or specialists while assessing her emotional needs early. This is important because mental health needs typically peak at the time of diagnosis. The case manager can perform a distress screening to assess a person鈥檚 state of mind, and the tool can make it easier for people to talk to their doctors about the emotional effects caused by the diagnosis, symptoms, and treatment of cancer.
When planning for surgery and looking for a chemotherapy regiment, our benefits utilization management team can work with the patient鈥檚 doctors and specialists to review and approve the proposed treatment plan. We can also get ahead on other necessary steps, such as assisting the employee with applying for disability so he or she can be out of work for treatment and recovery and making the entire process easier for them.
Q: What are some other benefits employers can gain when they integrate medical, pharmacy, and behavioral benefits?
Beyond cost savings and financial predictability, integrating benefits allows carriers like Cigna to proactively engage patients with service and clinical teams who identify, guide, and refer resources and care coordination across all of their benefits. Employers also benefit from integrated reporting and more streamlined administration of benefits.
Another advantage of integrated benefits is that it enables greater collaboration among providers on behalf of patients, which can lead to a simpler, more coordinated care experience and better health outcomes. For example, Cigna Pharmacy monitors customers who are taking opioids. If a customer鈥檚 morphine milligram equivalent is high, we will intervene, alert the member and their provider, and offer alternatives to pain management and services such as EAP and other behavioral counseling.
Q: How do integrated benefits work?
It goes well beyond the coordinating or bundling benefits. At Cigna, for example, we have one clinical platform for all our benefits that works in real-time to provide actionable insights, flag customer engagement opportunities, and enhance provider collaboration. When customers call us, we鈥檙e able to identify whether there is a health improvement opportunity and connect them to wellness programs, chronic condition coaching or behavioral services after answering their questions. Cigna鈥檚 connected platform enables us to intervene for the benefit of customers and contribute to important health care decisions, without delaying necessary care. This total healthcare approach focuses on the whole person and provides meaningful results.
Q: What should employers do who are interested in learning more?
Talk to your benefits provider about the possibility of integrating your benefits and building or expanding your employee engagement programs. If triple integration isn鈥檛 possible, integrate where and how you can for the benefit of your employees and your bottom line.