July 2020 newsletter
Quality Corner
Customer care and safety guidelines
Cigna Behavioral Health uses a variety of procedures and guidelines to assess network care and safety practices for customers who utilize behavioral treatment services. These procedures and guidelines include nationally accepted clinical practice standards, review of treatment records, access to care measurements, clinical practice guidelines, and quality of care complaint assessments.
Nationally accepted standards
Cigna uses the following procedures to promote the use of nationally accepted clinical practices:
- Analyzes safety practices and quality of care complaints from individuals
- Uses recognized standards for continuity and coordination between health care providers and facilities
- Strives for excellence in facility and health care provider treatment records
- Publishes standards for safety practices for behavioral health care providers
Review our guidelines for continuity and coordination of medical and behavioral care, continuity of care across behavioral settings, and excellence in record-keeping in the Quality Section of our Medical Management Program.
During key points of an individual's behavioral health treatment, such as initiation of case management services, qualified Cigna Behavioral Health staff may perform screenings for depression and substance/alcohol use. Where appropriate, referrals can be made for conditions co-managed by our behavioral care managers and Cigna's medical health care team. We encourage continuity and coordination of care and the importance of seeking consent for contact with primary care physicians (PCPs) and other professionals involved at important junctures in treatment.
Treatment records
Cigna conducts an annual review of behavioral health care provider treatment records. We review records for evidence of coordination of care with PCPs and communication with other behavioral health care providers, in the presence of executed consent. When a patient declines to provide consent, the health care provider record should indicate that the attempt to obtain consent was denied, but can ask in the future to coordinate care.
Access to care
- Rates for routine initial, routine follow-up, urgent, and emergent care are measured annually to see if health care provider performance meets expectations
- Transitions into care at different levels are studied to assure that they are efficient and appropriate
- Condition-specific case management services are available, based upon diagnosis and acuity, to support engagement and treatment compliance
Clinical Practice Guidelines
We review and adopt published guidelines from recognized sources, such as the American Psychiatric Association, American Academy of Pediatrics, and the American Society of Addiction Medicine. These guidelines are written and revised with appropriate peer review, and are based on scientific evidence and expert opinions. Cigna recommends that our network of behavioral health care providers and facilities use these guidelines.
For more information, visit the Clinical Practice Guidelines at the Cigna for Health Care Professionals website (CignaforHCP.com).
Quality of care
Cigna gathers quality of care information from customers who receive services from our network of behavioral health care providers. We assess a quarterly evaluation of rates for quality of care complaints and analyze the nature of those complaints. Based on our assessments and analysis, we provide feedback to behavioral health care providers and staff, where appropriate.
As a behavioral health care provider who shares our mission to help individuals, you are essential to help ensure that the individual's experience receiving care meets our high standards for quality and service. We appreciate your commitment to care and safety.