Tuesday, February 13, 2007

Contact with CIGNA

The following information was sent to Gregory Shannon, gregory.shannon@cigna.com who is responsible for decision pertaining to CIGNA's network of O&P providers. You may wish to join me in communication to Gregory!

Thanks, Gregory, for your response.

I appreciate your willingness to hear issues and consider these issues from the members perspective.

Having been in business for 30+ years ... and for most of that time having to deal with insurance providers from the perspective of a business purchasing coverage, I understand cost concerns and am a proponent of identifying cost saving strategies. My concern is that, in this case, the strategy employed has gone too far, to the extent that it is hurting the end user in such a manner that the cost savings are not sufficient justification.

You asked that I provide specific issues and suggestions and I want to honor that request. I will seek to do that in as consise a manner as possible!

ISSUES:

1. The relationship between CIGNA and Linkia creates a severe limitation to competition which I believe is already resulting in a deteriation in the quality of services to patients. This will inevitably drive providers out of business, allowing one provider to control an industry in a detrimental manner. (82% of independents already indicate a loss of market share to Linkia/Hanger).
2. The limitation in providers has added a great deal of complexity to a patient's ability to access care, often necessitating drives of 3-4 hours to access services, when a qualified provider is located right down the street.
3. By unreasonably requiring patients to change providers, the history that contributes to quality of care is lost.
4. Because Linkia is an additional layer in the provision of service, rates paid by Linkia to providers do not allow profitability required to remain in business. Their payments to their Hanger facilities and the minimal number of non-Hanger facilities who have been invited to participate in the network will result in losses by the providers, therefore eliminating an incentive to provide quality of care. Apparently, even some Hanger facilities have indicated their reticence to serve CIGNA patients because of the financial implications.
5. It appears that Linkia is not delivering quality of care as promised. Not only are patients in our state, and others, required to drive hundreds of miles to a facility, in many cases reported to me, Hanger has provided care in non-accredited facilities, by non-licensed or non-certified clinicians. I have been made aware already of cases in which care was inappropriate and has resulted in a need to have other, non-Hanger providers, complete the work in an appropriate manner. The limited reimbursement to the providers appears also to be resulting in shortcuts being taken in the care provided.
6. Inevitably, as competition is increasingly limited, Hanger will position itself to control rates charged to insurance providers, putting our future care and coverage in jeopardy. I believe within two years, CIGNA will pay an excessive price for the savings it is benefitting from today.

SUGGESTIONS:

1. Until further strategic plans are made to address this issue, allow all existing patients to continue to utilize their qualified providers with a request for continuity of care. Contract with the other significant network (OPGA/Point) to broaden the network of providers available to new patients.
2. Evaluate, with the assistance of provider input, cost reimbursement levels that are reasonable for a contracted provider (as a percentage of Medicare established rates).
3. Eliminate any exclusivity in your contract with Linkia/Hanger. Hanger's CEO has already stated that they do not require exclusivity.
4. Once reasonable rates have been determined, establish CIGNA's criteria for inclusion of a provider (I believe it is reasonable and prudent to require providers to be Certified and perhaps accredited) and offer contracts consistent with the reimbursement levels determined to be reasonable. This will reinstate reasonable competition in the provision of qualified care.

As I've indicated, I have created a website that contains a great deal of information about each of these issues. You can see a great deal of information and responses from patients and providers at http://www.gottrys.com/. Click on resources and also the blog.

I also encourage CIGNA to utilized patients to provide input that will help you make informed decisions. If CIGNA decides to do this, I would be very interested in being a part of a patient resource group.

Thanks for reading ... I'll be looking forward to hearing from you!

Daniel Gottry

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