Cigna Puts a Premium on Cancer Prevention

As model payment for healthcare services moves from fee-for-service to a system based on value, the health insurer Cigna is putting an emphasis on colon cancer prevention measures.

"A pound of prevention is worth an ounce of cure." – Benjamin Franklin

One of the worst perversions of fee-for-service medical care is the under valuing of prevention.

In the real world of human suffering, prevention is the ultimate value proposition. Preventing illness not only improves quality of life but also cuts treatment costs.

This concept is clearly on display at Bloomfield, CT-based Cigna, which began ramping up its efforts to increase colorectal cancer screening rates among its members in 2005. "At the time, our screening rates were comparable to what the national rates were, so there was room for improvement," Kathryn Pierce, director of clinical initiatives at Cigna, told me. "Colon cancer can be prevented or easily treated if detected early."

According to the American Cancer Society, colorectal cancer is the third leading cause of cancer-related deaths in the United States, and the disease is expected to kill 50,310 Americans this year.

Cigna's Colorectal Cancer Screening Program is making a difference. Last year, the company documented a 23.7 percent year-over-year increase in screening rates. Any boost in screening rates has the potential to save lives. And Cigna is cutting costs by paying for home test kits that indicate whether members should undergo more expensive testing such as a colonoscopy, which has an average cost of $1,185 in the United States.

This year, Cigna plans to reach two million people who are due for screening through a combination of targeted online messages and direct mail. More than 20 percent of health plan members who received an outreach message from Cigna in 2013 obtained a colorectal screening within six months of the intervention, according to the company.

Outreach is at the heart of the Cigna program. Anyone turning 50 or who becomes a Cigna health plan member past age 50 receives an educational brochure outlining all screening methods, which include a simple and sanitary home collection kit. "There are pros and cons to each of them," Pierce said of the screening methods. "For those who have used the kit in the past and have a preference for it, we send one directly. We take one step out."

The home collection kits are distributed by Madison, NJ-based Quest Diagnostics and are "very easy to use," Pierce told me. The collection is conducted after a bowel movement, requiring "a gentle brushing of the stool in water for about 5 seconds," according to information provided by Enterix, the company that makes the kit." The brush is able to pick up any blood in the water "that may be the result of bleeding the person may not be aware of," said Pierce.

The patient sends the collection kit to a Quest lab for testing and Quest notifies the patients about the results. A positive result prompts a recommendation to undergo further screening through their physician such as a colonoscopy.

Pierce said the vast majority of Cigna health plans cover colorectal screening "at 100 percent."

Healthcare providers are key partners in Cigna's Colorectal Cancer Screening Program, Pierce told me, noting the company's survey data has found that a doctor's recommendation is the No. 1 reason people get screened. "We have partnered with physicians with great success," she said.

Pierce told me Cigna's screening program is saving the company money, but she said the value of the effort goes far beyond the bottom line. "There definitely is a financial return," she told me. "But the thing you can't quantify is the lives saved. [The screening program] promotes a culture of health. It will encourage them to get their screenings for other cancers and cardiovascular disease."

Prevention potentially saves lives, cuts costs and "moves the needle" on overall health. That sounds pretty valuable to me.