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, and at least 1 inpatient admission in the past 12 months
  • COPD, and at least 1 inpatient admission in the past 12 months
  • Cancer, and at least 1 inpatient admission in the past 12 months

Exclusions

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

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

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

  • CHF, and at least 1 inpatient admission in the past 12 months
  • COPD, and at least 1 inpatient admission in the past 12 months
  • Cancer, and at least 1 inpatient admission in the past 12 months

Exclusions

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

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

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

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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.

Eligibility

  • 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)
  • diagnosis of ESRD
  • Type 1 or Type 2 diabetes
  • Pregnant (development of diabetes while enrolled in program will not affect eligibility)
  • < 18 years old

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

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Medical Community-Based 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

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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 hospital and home visits and phone-based consultation.

Eligibility

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

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

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

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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.