July 2020 newsletter
Quality Corner
Continuity and coordination of behavioral and medical care
As part of our continuity and coordination of care efforts, Cigna monitors the exchange of information between behavioral and medical providers. On an annual basis, behavioral providers are surveyed about the degree to which coordination with primary care providers (PCPs) occurs in the care they deliver to Cigna customers. Of Cigna's network providers who responded to our 2019 annual survey, 85 percent reported care coordination with PCPs, as compared with 84 percent in 2018.
According to the responses, the primary reasons why coordination does not occur include:
- Customers do not have an identified PCP, or
- When a PCP is identified, there is customer or provider concern about confidentiality
In addition, Cigna annually reviews the treatment records of contracted network providers and maintains a goal of 80 percent for documentation of efforts to coordinate care with the PCP, in the presence of customer consent. Cigna's 2019 review of contracted behavioral providers’ treatment records sought documented evidence that the provider asked if the customer has a PCP, and if so, whether the customer consented to releasing information and if the behavioral provider subsequently released information to the PCP. The 2019 score of 64 percent did not meet Cigna’s 80 percent goal, but increased from the 2018 score of 61 percent.
In 2019, Cigna implemented updates to the Treatment Record Review Tool to clarify what criteria qualify as coordination of care. Additionally, staff completing the audits were trained on the updated tool and an inter-reviewer reliability exercise was completed. Communications were distributed to the provider network informing them of the updates and the importance of continuity and coordination of care.
In cases where there is no collaboration, or where the exchange of clinical information could be improved, Cigna Provider Relations staff contacts providers to discuss the importance of coordination of care. For more information, visit the Quality Management section in the Medical Management Guide on the Cigna for Health Care Professionals website (CignaforHCP.com).
Cigna encourages consideration of appropriate coordination of medical and behavioral care for all of our customers. This is particularly important to improving the overall health care for individuals with co-morbid medical and behavioral conditions. Cigna recognizes that it may be appropriate to seek customer consent for communication more than once in the course of treatment, even if the customer has declined the initial request. As a behavioral network provider, you may find it helpful to review Cigna’s guidelines and tools for coordination of medical and behavioral care in the Quality Management section and in Appendix G of our Medical Management Program Guide at CignaforHCP.com.