The Cigna Care Designation Program is a specialized network option within Cigna healthcare plans, designed to guide members toward physicians recognized for their quality and cost-effectiveness. Responding to member demand for greater transparency in healthcare provider selection, Cigna developed this program to highlight doctors who meet specific benchmarks in both care quality and efficient resource utilization. Available across 74 service areas nationwide, the Cigna Care designation acts as a valuable tool for patients seeking high-value healthcare within the Cigna network.
Decoding the Cigna Care Designation
Within the Cigna provider directory, physicians who have earned the Cigna Care Designation are easily identifiable by a distinct icon displayed next to their names. This visual cue signifies that these practitioners have been evaluated against rigorous criteria encompassing both quality of care and cost efficiency within their respective specialties. While all Cigna participating providers are considered in-network, choosing a Cigna Care Designated physician may lead to reduced out-of-pocket expenses for plan members, typically in the form of lower co-payments or coinsurance. For those seeking deeper insights into the program’s methodology and benefits, Cigna provides comprehensive whitepapers accessible via their healthcare professional resources online.
Who Benefits from the Cigna Care Designation?
The Cigna Care Designation program offers tangible advantages to both Cigna members and employers sponsoring Cigna plans. For members, the program simplifies the process of selecting healthcare providers by highlighting those who have demonstrated a commitment to high-quality, efficient care. This can translate to greater confidence in their healthcare choices and potentially lower healthcare costs through reduced co-pays and coinsurance when choosing designated physicians. Employers, in turn, can offer Cigna Care Network plans as a means of promoting cost-conscious healthcare utilization among their employees while maintaining access to a network of vetted, quality-focused physicians. This aligns with broader efforts to manage healthcare expenditure and ensure employees receive optimal care.
Geographic Availability of the Cigna Care Network
The Cigna Care Network extends across numerous states and metropolitan areas, offering broad access to designated physicians. Currently, the network is available in the following service areas: Arkansas (Little Rock Metro), Arizona, California (including major regions like Los Angeles, Orange County, San Diego, San Francisco, and Sacramento), Colorado (Denver, Colorado Springs), Connecticut, Delaware, Florida (Orlando, Tampa, South Florida, Jacksonville, and Ocala), Georgia, Illinois (Chicago Metro, Champaign, Urbana), Indiana (excluding Evansville Metro), Kansas/Missouri (Kansas City), Louisiana, Massachusetts, Maryland (including Washington, D.C.), Maine, Michigan (HAP), Mississippi, Nevada, New Hampshire, New Jersey (Northern and Southern), New York (Metro New York), North Carolina, Ohio (Northern, Central, Southern), Oregon (Portland), Pennsylvania (Philadelphia, Pittsburgh, and Eastern/Western PA), Rhode Island, South Carolina (markets vary), Tennessee (Memphis, Nashville, Knoxville, rural TN), Texas (Dallas, Ft. Worth, Houston), Utah, Virginia, Wisconsin, and West Virginia. This extensive reach ensures that a significant portion of Cigna members can benefit from the Cigna Care Designation program.
How Physicians Achieve Cigna Care Designation
Cigna employs a thorough evaluation process to determine which physicians receive the Care Designation. This assessment is conducted at least every two years for participating specialists across 21 specific specialties, including primary care types like Family Practice, Internal Medicine, and Pediatrics, alongside specialties such as Cardiology, Dermatology, and Oncology. The evaluation is based on two core pillars:
Quality Evaluation
Cigna’s quality assessment incorporates publicly recognized benchmarks and evidence-based measures. Criteria include:
- NCQA Recognition: Acknowledges physicians recognized by the National Committee for Quality Assurance (NCQA) in areas like diabetes care, cardiac and stroke care, back pain management, and patient-centered medical home principles.
- Adherence to Quality Measures: Evaluates physician compliance with selected, evidence-based quality guidelines and protocols.
- Group Board Certification: Considers board certification status at the group practice level as an indicator of collective expertise.
Cost-Efficiency Evaluation
Cost-efficiency is assessed by comparing a physician’s resource utilization and billing patterns against their peers within the same specialty and geographic area. This involves analyzing:
- Fee Schedules: Examination of physician fee structures relative to market averages.
- Utilization Patterns: Analysis of service utilization rates and practice efficiency.
- Referral Patterns: Review of hospital and facility referral habits to gauge cost-conscious resource management.
Physicians are then categorized into three tiers based on their cost-efficiency compared to their peers:
- Three Stars: Represent the top 34% most cost-efficient physicians.
- Two Stars: Represent the middle 33% in cost efficiency.
- One Star: Represent the lower 33% in cost efficiency.
It’s important to note that while the Cigna Care Designation highlights specific physicians, all participating Cigna providers remain in-network. The designation simply serves as a guide to help members identify those physicians recognized for delivering both high-quality and cost-effective care within the Cigna network.
Impact on Physician Reimbursement and Member Coverage
The Cigna Care Designation program is structured to encourage members to choose designated physicians by offering enhanced coverage levels. Specifically, members selecting Cigna Care Designated physicians typically benefit from lower co-payments or coinsurance compared to seeing a non-designated, but still in-network, provider. Crucially, the program does not alter the overall reimbursement rates for physicians. Instead, it strategically directs member cost-sharing incentives to encourage the utilization of physicians recognized for their efficient and quality-driven practices. Members retain the flexibility to seek care from any Cigna participating provider, but those who opt for Cigna Care Designated physicians will experience the most advantageous coverage terms under their Cigna Care Network plan.
