The Cigna Health Insurance Story Starring Six Sigma

The story begins with Cigna wanting to better help their clients who had more complex medical issues. So initially, Cigna Behavioral Health developed an Intensive Case Management program (ICM), with its purpose to eliminate or at the very least reduce the readmission rate.

The patients were assigned personal care managers who would work with them. These managers would educate the patient about their disease, which also included speaking to their families about the medications as well as helping to assist in the patient’s treatment plan with mental health and other medical providers. 

Even after all these efforts, readmission rates were still very high, especially for mental illness and substance abuse.

Enter Six Sigma! The approach was simple: they began a project using the DMAIC template to find the possible causes for such a high readmission rate. They needed to determine the missing gap that caused the missed goal, and since it was such a wide gap, something needed to be fixed. So after using the DMAIC template (Define-Measure-Analyze-Improve-Control), the findings proved interesting.

Here were the results:

• The readmission data was incorrect and misleading.
• The accountability of the high-risk patients was inadequate.
• The follow-up plans for these high-risk patients was inadequate.
• The follow-up communication did not add value, it wasn’t effective.

The Improvements:

• Create and redefine a customer-focused readmission goal.
• Create an improved discharge and follow-up plan for the patient.
• Give auto ICM enrollment both to providers and patients.
• Improve communications and delivery.
• Implement all protocols and training for all care coordinators, which includes employee assistance programs and all nonclinical services.

The results after one year:

• A 53% decrease in readmissions.
• A savings of $3,000 per patient as well as a 49% decrease in inpatient care expenditures.
• A 14.9% improvement in the rate of patients taking their medications as prescribed.

The project was a huge success, although it took a year and a lot of data, Cigna achieved their goal and continues to do so.

Interested in improving systems at your healthcare organization? For more information on our Lean Six Sigma courses and services, please visit 6sigma.com. 

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