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Cigna study shows benefits of integration across medical, behavioral and pharmacy

The study, conducted prior to the insurer getting approval to acquire Express Scripts, shows a 9 percent reduction in high cost medical claims.

Susan Morse, Senior Editor

A new study released by Cigna shows that the integration of  medical, behavioral and pharmacy benefits at the company saves $193 per covered individual and increases participation in health coaching and case management programs by 22 percent.

WHY THIS MATTERS

Cigna, in September, received Department of Justice approval to acquire pharmacy benefits manager Express Scripts for $67 billion.

CVS Health is expected to close its $69 billion deal to buy Aetna.

The study does not make a direct link in having a connected insurer and PBM to achieve the benefits of integration, and in fact, the study is based on customer claims studied from January 2016 to December 2017, before the merger was approved. The deal has yet to close.

But there is clearly an incentive for the proposed vertical integrations between insurers and pharmacy benefit managers, and the number one factor is cost savings.

Cigna's pharmacy benefit manager during the study was OptumRx, the PBM for the nation's largest health insurer, UnitedHealthcare.

THE TREND

Employers who offer integrated medical, comprehensive behavioral and pharmacy benefits administered by Cigna show positive health outcomes for individuals and lower costs, such as $9,792 in medical  savings due to Cigna's engagement with members who have a specialty condition such as multiple sclerosis or rheumatoid arthritis. When people being treated for diabetes are engaged, the savings is $5,900, Cigna said.

The study shows a 9 percent reduction in high cost medical claims for customers with integrated benefits and a 10 percent reduction in out-of-network claims.

WHAT ELSE YOU NEED TO KNOW

Cigna's 2018 value of integration study examined approximately 4.9 million customer claims nationally from January 2016 to December 2017 from medical claims for group benefit plans. Approximately half of the population had comprehensive medical, behavioral and pharmacy benefits administered by Cigna while the other half had only medical benefits with standard behavioral benefits administered by Cigna.

Customers were matched between the two groups on key attributes, including demographics, health condition, access to health improvement services, plan design and geographies.

Cigna engaged KPMG LLP to perform a review of its analysis of medical cost savings benefits from integration.

ON THE RECORD

"A person's physical and mental health are connected, and health care is best delivered – and produces the best outcomes – when it is connected as well," said Dr. Scott Josephs, national medical officer at Cigna. "The results of this study demonstrate the value of our integrated, holistic approach to health care, and we'll continue to advocate for more integration on behalf of the people we serve."

"Offering a fully-connected pharmacy benefit allows us to maximize every opportunity available to engage the people we serve, and we're encouraged by the consistent value shown by connecting medical, behavioral and pharmacy benefits," said Jon Maesner, chief pharmacy officer at Cigna.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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