Cigna Meets with Natrona County Medical Society

The Natrona County Medical Society hosted a roundtable with Cigna representatives at the Casper Country Club on Wednesday night. After nearly an hour discussion with Casper-area doctors,
Cigna opened up a panel discussion regarding cost drivers moderated by Kim Bimestefer, Mountain States President of Cigna as well as (from left) Ralph Hayes, Joe McGinley, MD, PhD, Mark Laitos, MD, and James Bush MD.

Cigna and Natrona County Physicians Meet To Talk Recontracting

By Tom Lacock
Wyoming Medical Society

CHEYENNE – A group of nearly 25 Natrona County Medical Society (NCMS) physicians met with representatives from Cigna, the Wyoming State Employees Health Plan, and Wyoming Medicaid on Wednesday night in Casper.

The conversation was far-ranging, but began as an opportunity for NCMS members to pick the brains of Cigna representatives, specifically regarding a re-contracting effort by Cigna over the past six months that has led to less physician reimbursement. The meeting started with the Natrona County physicians discussing their concerns with Cigna before a Cigna-sponsored dinner and a panel discussion brought in other community leaders.

Before dinner, Cigna’s Mountain States President Kim Bimestefer cited the state’s recession, and the fact Wyoming providers are paid on a percent off on charges (a rarity, said Bimestefer)  as the reasons for the cuts. Bimestefer said there were physicians in the Casper area who are charging 10 to 20 times Medicare reimbursement and said that needs to change.

“We want you in-network,” Bimestefer said who went on to say she would work with physicians in Natrona County who didn’t believe the re-contracted rate was appropriate. “I don’t know what that number is, but it isn’t 20 times Medicare.”

NCMS President Joe McGinley, MD, PhD said he felt the physicians of the state were being targeted and said he didn’t believe Cigna needed a cut given its 2014 revenue of $14.6 billion, up from $7 billion in 2006. Bimestefer responded that the State Employees Health contract is self-funded and savings would go directly to the state instead of Cigna but admitted the need to return a profit from management of the account to shareholders.

“I feel like we are seen as an easy target for health costs, but of all the health costs nationwide, we only account for 8 percent,” said McGinley.

Bimestefer agreed with physicians being a relatively small cost of the health care pie but added hospitals account for 40-50 percent of healthcare costs. For that reason, she said Cigna is also negotiating with 28 Wyoming hospitals to change their reimbursement rates.

The conversation wasn’t consistently adversarial. Casper oncologist Robert Tobin, MD pointed out he sees Cigna as one of the better payers in his mix and suggested physicians are often asked by patients for health insurance companies who are easy to work with on pre-authorizations for procedures and pay their doctors well. Tobin suggested Cigna continue their strong payment history as it makes Cigna easier to recommend to patients.

The evening did provide a chance for NCMS members to discuss concerns with Cigna outside of the reimbursement realm as well. Those practicing addiction medicine and mental health care expressed frustration with Cigna’s authorization policies in their specialties. Bert Toews, MD  pointed out he feels the concept of peer reviews of his recommendations is insulting as those doing the reviews don’t have his credentials in addiction medicine. Mark Laitos, MD, Medical Executive for Cigna’s Mountain States operations said not every specialty gets a peer review by someone inside that specialty.

“We also don’t have enough orthopedic physicians to review every case on a peer-to-peer basis, our workforce is primarily primary care physicians. That is simply because our company can afford to have more primary care physicians on-staff.”

One area physicians and Cigna did agree on was Medical Malpractice Reform. When asked the impact on testing due to concerns about lawsuits, Laitos said he believes a lack of caps does result in higher cost for the delivery of care in the Cowboy State.

“There is a distortion in the cost of healthcare due to that threat of lawsuit,” Laitos said. “Rates in Wyoming are not the same as they are in Colorado because of that.”