Presentation on theme: "Government Influences on Cigna Business Acumen Course August 27 th, 2014."— Presentation transcript:
Government Influences on Cigna Business Acumen Course August 27 th, 2014
2 Affordable Care Act aka Patient Protection and Affordable Care Act (“PPACA”) Signed into law March of 2010, but 2014 is key date. Key Mandates: No Medical Underwriting / No exclusions for pre-existing conditions Mandated coverage – individuals must buy, employers must provide Essential Health Benefits (100% Preventative Care) MLR Requirements Plan Tier Levels http://www.cigna.com/health-care-reform/
3 ACA and Cigna Focus on Brand and Mission Statement Politically active; advocacy for the industry Care management/Wellness (personalization) Select, Targeted Markets LocalPlus Networks
Public Exchanges 4 Current State / Impact on Cigna: By 2014, a Health Insurance Marketplace offering medical and dental, is required to be operating in every state as a new option for individuals and small employers to purchase health insurance. At this time Cigna will only participate in the individual marketplace. Cigna has identified five states for participation in the public health insurance exchange marketplace: Arizona, Colorado, Florida, Tennessee and Texas. Cigna will also offer dental plans on the exchanges in these states. Cigna will continue to offer Individual and Family medical and dental plans off the exchange in those states as well as the other five states in which we offer currently individual plans: California, Connecticut, Georgia, North and South Carolina. Future State / Impact on Cigna: After extensive analysis we have decided to focus on a subset of exchange markets in the best locations where we can provide exchange participants with access to the best care at the best price. Cigna’s decision to participate in exchanges in five markets does not preclude participating in additional state exchanges in the future. Cigna will reassess this decision after learning more about operating in exchange markets.
Private Exchanges 5 Current State / Impact on Cigna: Private group plan exchanges offer an alternative to public exchanges by providing a marketplace for individuals and groups to purchase medical and other benefits. These exchanges are a private-label offering, hosted by a 3rd party or carrier, for the purpose of purchasing employer-sponsored benefits. Cigna believes it is important to participate early and shape direction of exchange solutions across all of our segments. We have private exchange solutions for clients of all sizes and target our participation to those models that best align with our mission and value proposition, and allow us to continue to evolve to meet the varying needs of employers. Cigna is participating in 11 Private Exchanges, including Mercer, Towers Watson, Aon Hewitt and others. Most of our competitors are active in the Private Exchange space Cigna has developed our own proprietary Retail Exchange solution, Cigna Guided Solutions. Future State / Impact on Cigna: Cigna expects to have broad availability in Select and Regional markets by 1/2015. Cigna will continue to assess each opportunity and anticipate participating in other Private Exchanges in the future Private Exchanges are a major growth opportunity – as referenced in the 2013 Annual Report. David Cordani stated “We view private exchanges as a potential long-term growth opportunity. We’ll continue to monitor evolving programs, and we’re poised to go deeper into private exchanges should they prove to deliver differentiated value to customers”.
About CMS “CMS covers over 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. “ Contract with CMS to provide services to Medicare beneficiaries Compliance with complex regulations What we can sell Enrollment and expansion Sales & Marketing Ethics & Fraud Prevention
Cigna Senior Segment Offer products that complement Medicare
Cigna Senior Segment Financial Statement and Membership Snapshots (In thousands, except MCR) 20132012 Medicare Advantage Revenue$ 5,639$ 4,969 Membership467426 MCR84.8%80.9% Medicare Part D Revenue$ 1,387$ 1,421 Membership1,1901,264 MCR82.3%81.2% Global Health Care Revenue$ 22,933$ 20,973
9 CIGNA-HEALTHSPRING 2014 MEDICARE ADVANTAGE MARKETS Note: All service area expansions are pending CMS contract approval. Updated 08/2013. Pinal County, Arizona, Miami-Dade County, Florida, and Cobb County, Georgia are partial counties. Existing 2013 Cigna- HealthSpring counties New 2014 Cigna- HealthSpring expansion counties Key
CMS and Medicare Advantage Plans Medicare Advantage Plans (Part C) Cigna contracts with CMS to provide Part A and Part B benefits CMS payment forms bulk of revenue Risk score is dependent on HCC (Hierarchical Condition Categories) – improving provider coding improves our revenue Quality measurement metrics (star ratings) – improving metrics improves our revenue and attracts members Sequestration – reduced payments by 2% and will continue through 2023 MLR Requirements of 85% Improved contracting with provider networks – help to mitigate payment reduction
CMS and Part D Plans Part D = Prescription drug plan offered through Medicare.gov Plan Design Revenues Direct subsidy Coverage Gap Discount Program (to close the “donut hole”) Sequestration Solutions Formulary adjustments Plan design changes Catamaran alliance