An Ounce of Prevention

Providing the appropriate tools to increase the decision-making power of health plan members has been a key goal of the consumer-directed healthcare trend. Healthcare provider CIGNA Behavioral Health (CBH; Eden Prairie, Minn.), a subsidiary of CIGNA (Philadelphia; $668 million in 2003 net income) has taken consumer-centric technology a step further with an online coaching application that provides access to treatment and reduces long-term health insurance payouts through prevention.

Last year, CBH took note that 20,000 members who were referred for behavioral coaching attended only a single session. An additional 17,000 went just twice. In some cases, one or two visits may have been adequate, but in many more, people are avoiding needed interaction, according to Jodi Aronson Prohofski, Ph.D, CBH's senior vice president, clinical operations. "Sometimes people can't get over the stigma, other times they say, 'It doesn't fit into my schedule,' and sometimes they don't click with the provider they went to see," she explains.

Automated Dialogue

While Aronson Prohofski emphasizes that online interaction is not always a good substitute for face-to-face interaction, CBH sought to build an interactive online tool to address members' behavioral issues in a semi-automated forum. The application allows members to identify themselves anonymously through self-selected user names and passwords. It then guides them through an interview process, "posing simple questions, one at a time, similar to how a clinician would pose a question to a patient," says Aronson Prohofski.

While members are free to seek help 24 hours a day, the technology is supported by a live clinician, who responds to "homework" submitted. Rules-based triggers catch what Aronson Prohofski calls "words of concern" that indicate that a member's questions cannot suitably be addressed through the application. "If the system notices those more clinically concerned words, it will pop up a message to the user suggesting that the program might not be appropriate for them, as well as providing a contact phone number," she relates.

While much of CBH's Web technology is Java-based, its Emotional Well-Being content, including the coaching application, was built on Microsoft (Redmond, Wash.) technologies. "The system was built using an n-tier application architecture, with the business logic layer composed of Visual Basic 6.0 COM components running under Microsoft Transaction Server," says Dave Carl, director of e-commerce and data warehouse, CBH.

Implemented Jan. 1, 2004, the online coaching program has reached more than 100,000 individuals to date. "This will create greater access to the tools members need, which is always a big issue for employers and insurance carriers," Aronson Prohofski says. "If [members] get the access as early as possible, you'll prevent bigger and more costly problems."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio