2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

CIGNA HealthCare Performance Guarantee Agreement
Customer Bridgeport City BOE
Effective Date July 1 2010
Account Number s involved in Performance Guarantee s 321317 2
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CIGNA
3 Additional Terms
3 1 The Guarantee Periods for specific
Performance Guarantees are set forth in
Exhibit A beginning on the Effective
Date
4 Disease Manalement Metrics
4 1 Additional Conditions
4 1 1 For Disease Management Performance
Guarantees a Employer must have
purchased the Disease Management
programs for a minimum of 3000
Participants in each ofthe Disease
Management programs listed in Exhibit
A b Employer must have purchased
the Medical Management Full
Program c Employers must make
available to Connecticut General
required historical claim data and
pharmacy claim data to establish the
Baseline Period and d Employers new
to Connecticut General must complete
the jumpstart process prior to the
Effective Date which combines
historical claim data and pharmacy
claim data for the Baseline Period with
current eligibility information
4 12 For the Disease Management Saving
Target Performance Guarantee
Employer must purchase the 5 Core
Well Aware Client specific
Programs
Savings Target Guarantee calculation
does not include fees nor the savings
realized through Weight Complications
Depression or Targeted Condition
program
4 13 For the clinical improvement
guarantee s Employer must purchase
and retain for the duration ofthe
Guarantee Period the program associated
with the performance guarantee s
For
example to be eligible for Improvement
in the percentage ofAsthma Participants
with persistent asthma who are
prescribed asthma medication Employer
must purchase Asthma Program
4 14 Connecticut General will use required
historical pharmacy claim data and
historical claim data provided by
Employer to establish the Baseline
Period along with the jumpstart
program for new Employers that
combines the Ba1 eline Period
information with current
Participant
eligibility information to identify
Participants with chronic disease
conditions for paJiicipation in Well
Aware Programs and to evaluate Disease
Management Performance Guarantees
4 1 5 Plan Participants with more than one
chronic disease
Diabetes Cardiac
Disease CHD
defined here as Asthma
Chronic Heart
Lower Back Pain LBP
and Chronic Obstructive Pulmonary
Disease COPD will only be considered
to have one primary diagnosis e g an
Asthma Participant will not also be
considered a Diabetes or CHD
Participant
4 1 6 Client Specific Savings Target guarantee
calculation does 110t include fees or the
savings realized through Weight
Complications Depression or Targeted
Condition program
4 17 Retirees are included
4 2 Disease Management Measurement
Performance Guarantees shall be
measured using the Detailed
Measurement Methodology set forth in
Table I which m lY be periodically
adjusted to reflect Connecticut General s
current practices Connecticut General
incorporates three 3 months ofrun out
claim experience related to the Guarantee
Period in conducting its analysis of the
performance of the Well Aware Program
43 Savings Target Measurement Reduction
in health care costs will be determined by
Connecticut General by comparing the
PDPPM Costs for the Guarantee Period
to the PDPPM Costs for the Baseline
OS 28 20I 0
20I0 Performance Guarantee Page 24