Patient Support Programs

Medicare Advantage resources to supplement your care

Medically complex patients benefit from tailored interventions. Cigna's patient support programs can serve as a customizable adjunct to your treatment plans. Supported by a multidisciplinary team of professionals, these programs enable early intervention for your patients with medical, pharmaceutical or behavioral health needs. Programs are both in-home and community-based.* All programs are offered at no additional cost to the patient.

  Benefits for you and your team:     Benefits for your patients:
  • Short-term and complex care management
  • Assistance coordinating services and community resources
  • Targeted efforts to prevent or manage complications
 
  • Improved self-management skills
  • Improved medication adherence
  • Closed gaps in preventive care measures

View program descriptions and eligibility criteria below:

In-Home Programs

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Chronic care management focuses on your top health care utilizers, improves the health of patients needing in-home support, and develops personalized care plans.

Eligibility
Patients must have at least one of the following:

  • CHF, COPD, Asthma, CKD, DM, CAD, Dementia
  • 2 or more hospitalizations, or 3 or more ER visits in the past year

Exclusions

  • Active cancer treatment requiring frequent hospitalizations
  • Chronic pain or psychiatric issues as the primary source of hospital utilization

Participating markets: Illinois, Maryland, Pennsylvania

Complex care management focuses on top health care utilizers, improves the health of patients needing in-home support, and develops personalized care plans. In-home nurse practitioners partner with the primary care physician to develop and deliver personalized care plans.

Eligibility In
Patients must have at least one of the following:

  • CHF, COPD, Asthma, CKD, DM, CAD, Dementia
  • 2 or more hospitalizations, or 3 or more ER visits in the past year

Exclusions

  • Active cancer treatment requiring frequent hospitalizations
  • Chronic pain or psychiatric issues as the primary source of hospital utilization

Participating markets: Alabama, Illinois, Tennessee, Texas

Our advanced care program reduces hospitalization risk, manages symptoms, improves quality of life, organizes the home environment for better care delivery, and provides advanced care planning.

Eligibility
Patients with advanced illness who require home-based care; most commonly those with:

  • CHF (Class III–IV)
  • COPD (Stage III–IV)
  • End Stage Renal Disease (ESRD)
  • Dementia
  • Frailty and impaired mechanical health
  • Cancer

Participating markets: Alabama, Illinois, Tennessee, Texas

Transition of care ensures a smooth transition from hospital to home and reduces hospital readmissions.

Eligibility
Patients with a strong likelihood of a readmission based on diagnoses, comorbidities and/or functional health status

Participating markets: Alabama, Georgia, Illinois, Maryland, Pennsylvannia, Texas

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Disease Specific Programs

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This pre-diabetes management program was developed by the Centers for Disease Control and Prevention (CDC) and promotes healthier lifestyles and weight loss to reduce Type 2 diabetes risk.

Medicare Diabetes Prevention Program (MDPP) is a covered preventive benefit for eligible patients with Cigna Medicare plan coverage. The MDPP includes the following components:

  • Core Services: 16 weekly lessons over 6 months, followed by monthly sessions for months 7-12.
  • Ongoing Maintenance: Second year of maintenance sessions for those who meet the 5% weight loss goal and attend a minimum of 2 sessions per 3-month period.
  • Lifestyle health coach to help set goals and keep participants on track
  • Small, in-person group support

Patients must complete a blood screening test at an in-network lab within 12 months prior to enrollment and meet the following requirements to qualify for the program.

Eligibility:

  • Enrollment in Medicare Part B
  • BMI greater than or equal to 25 (or if Asian, greater than or equal to 23)
  • For patients with one of three blood tests conducted within one year before the first core session:
    • Hemoglobin A1c test with a value of 5.7-6.4% or
    • Fasting plasma glucose test with a value of 110-125 mg/dl or
    • Oral glucose tolerance test with a value of 140-199 mg/dl

Exclusions:

  • BMI <25 (if self-identified as Asian, BMI <23)
  • ESRD diagnosis
  • Type 1 or Type 2 diabetes

To Make a MDPP Referral:

  • Search for MDPP in the local service area (click the view data button then search by zip code).
  • Click the Export button to save a copy of the file, as a CSV. (Note: this list is refreshed quarterly).
  • Call a local MDPP for the patient or provide your patient the name and phone number of the organization on the local list. The office may have to provide clinical data to the MDPP in order for the patient to qualify.

All markets participate in this program.

Questions?
Contact Provider Customer Service at 1 (800) 668-3813. Arizona providers call 1 (800) 627-7534.

Our Chronic Kidney/End State Renal Disease support consists of three episode-focused in-home care management programs.

Eligibility

  • CKDelay is for patients with Chronic Kidney Disease with Stage 3b or greater with approximate GFRs < 44 and > 20 and are not expected to experience kidney failure in the next 12 months.
  • Advanced CKD Transitions (ACT!) is for patients diagnosed with CKD Stage 4 with approximate GFR < 20 who are expected to experience kidney failure within the next 12 months.
  • ESRD Care Optimization (ECO) is for patients who are already diagnosed with ESRD and are on dialysis or post-transplantation with a GFR of 12 or lower.

Exclusions

  • Actively receiving hospice care

All markets participate in this program.

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Medical Programs

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This program treats complex medical or behavioral health issues, provided by Cigna Medicare Advantage employed nurses or social workers who conduct assessments of your patient’s health status, social determinants of health, and gaps in care utilizing a multidimensional, evidenced-based approach to identify opportunities for impact.

Eligibility

  • High utilization; 2 admissions in 12 months or 3 ER visits in the last 12 months
  • Multiple co-morbidities

All markets participate in this program.

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Behavioral Community-Based Programs

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A community-based care coordination team of licensed behavioral health professionals will coordinate with providers, hospital staff, and other community resources on behalf of your patients with complex behavioral health needs. This team works directly with your patients during phone-based consultation.

Eligibility

  • Severe and persistent mental illness
  • 1+ psychiatric patient admissions

All markets participate in this program.

This program offers prevention, detection, and education for patients about available treatments and services for managing depression and includes:

  • A 12-week program including education, mailings and one-on-one telephone support
  • A dedicated behavioral health coach
  • Monitoring of medications or treatment
  • Connections to community resources

Eligibility

  • Patients with symptoms of depression

All markets participate in this program.

This program focuses on an integrated, holistic approach for customer with behavioral health conditions and provides care coordination and coaching to ensure optimal utilization of health care resources and quality care.

Eligibility:

  • Patients with depression, anxiety, and/or substance use disorder who are most at risk for avoidable utilization of health care services or worsening status in their health due to co-morbidities.

All markets participate in this program.

The Behavioral Health Unit offers free educational coaching programs which provide patients with telephonic support and educational resources for managing their health. Patients benefit from early intervention, education and support group information, and referrals to in-network providers.

Eligibility

  • Patients with substance use issues

All markets participate in this program.

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     Questions?


     To request an eligibility assessment review for your patient or learn more, contact Cigna Medicare Advantage:

     Include:

    • Provider name and phone #:
    • Patient name:
    • Patient health ID #:

     Remember to use secured email when sending patient PHI or diagnostic information in order to protect patient
     information.

*Cigna reserves the right to enroll a patient in the most appropriate clinical support program.