Cigna President of Mountain States Kim Bimestefer presents to a room of physicians
Thursday in Laramie.

By Tom Lacock
Wyoming Medical Society

The second in a series of three dinner meetings hosted by health insurance firm Cigna took place Thursday night in Laramie featuring debate on the impact of the state employee’s health insurance plan on provider reimbursement.

As with the first meeting, Cigna Mountain States President Kim Bimestefer opened the meeting with a presentation explaining Cigna’s position in the Wyoming market as well as its intention to once again bid on the state contract when released in May, which brings with it 38,000 covered lives. According to a 2015 HealthLeaders study Cigna has the highest commercial enrollment in the state – thanks largely to the state contract – with 29 percent of the market. Blue Cross Blue Shield has 23 percent of the market and United Healthcare another 13 percent. She suggested losing the state contract would be a 15 percent swing.

Ralph Hayes of the State Employees Insurance Group told the crowd that 15 years ago the state spent $34 million on healthcare. Last year it spent $269 million. As a result, Bimestefer said the state is asking Cigna to help it cut down on costs as it considers its response to the state proposal. Cigna responded this winter with a letter to physicians in Laramie, Albany, and Natrona Counties explaining it was cutting provider reimbursement as a form of cost control ahead of the state bid. According to Bimestefer 38 percent of every healthcare dollar spent by Cigna goes to physicians. She said another 40-50 percent goes to hospitals with the rest going to labs, radiology, and pharmacy.

WMS Board President Sigsbee Duck, RPh, MD, was in attendance to represent the Wyoming physicians. He offered a fiery response to the Cigna presentation suggesting physicians are seeing repeated cuts and continuing to do so is not a solution to lowering healthcare costs. Instead, he suggested the state look into tort reform as well a culture of over-testing.

“It seems like everyone who comes to me with a sore throat has already had a MRI or CT scan,” Duck said. “You are punishing us and that is not going to cut it.”

Bimestefer once again apologized for the way the cuts were announced, but added that since the letters concerning recontracting had been sent, Cigna has done extensive follow-up and is willing to negotiate on an office-by-office basis.

Thursday, Bimestefer said in its proposal to the state, Cigna will offer programming to help state employees cut down on tobacco use, lose weight, and seek fewer back surgeries in order to address healthcare costs. She also suggested the state is asking for more of an emphasis on telehealth in this RFP, while also reconsidering the 5 percent contracting preference for in-state organizations such as physician offices. Physicians in the room suggested caution when implementing new strategies for cutting down on back surgeries and Bimestefer asked their help in developing new policies around that effort.

In the latter half of the meeting, Cigna’s medical director Dr. Mark Laitos pointed out it is rare that Cigna pays a percent off charges anywhere but Wyoming and is seeking a more value-based approach with an eye towards more population health efforts in the realm of tobacco, and obesity.

A primary care doctor in Laramie said he struggled to recruit new providers to his small office because of what he could pay and the cuts would impact those efforts. Bimestefer said she agreed Wyoming can be a tough place to recruit and suggested other states have done well to recruit through use of reimbursement of medical school loans for those coming out of residency.

When quizzed about the impact to Wyoming physicians that Cigna’s proposed merger with Anthem Healthcare would have, Bimestefer said the intention is for Cigna and Anthem to partner in areas where the other is more successful. She used the example that Anthem has a better track record on individual health exchanges than Cigna, which she said lost $1 billion on the exchanges over the last two years. She also said Anthem cannot compete with Blue Cross Blue Shield in Wyoming and that they exist in just 14 states.