Cigna Health Matters Care Management targets rising-risk members with complex conditions, per Cigna.
Cigna describes Health Matters Care Management as a clinically based program that uses predictive modeling to reach rising-risk employees. The employer page gives the concept but few operating details.
What the program is and what members do.
What the program is
Cigna says the program is designed to deliver better outcomes and savings to the employee and the employer. It describes a foundation of clinical expertise and advanced predictive modeling used to identify rising-risk customers.
How members use it
Cigna describes a personalized engagement experience to support employees facing complex medical conditions. The page does not describe the channel, the staff involved or how often contact happens, so we would ask.
What the page does not say
Cigna’s page does not provide results, a savings figure or a list of conditions for this program, and we have not added any. Cigna’s footer says plans contain exclusions and limitations.
Eligibility, funding and plan design.
Who can use it
The audience as stated is employees who are rising-risk or facing complex medical conditions, identified by Cigna’s modeling. Members are identified for outreach, so a member may not enroll on their own. We would confirm that with Cigna.
How it is funded or sold
Cigna’s footnotes say group insurance is offered to employers with more than 50 full-time employees in most states, and administrative services for self-funded plans with as few as 25 full-time employees. Product availability varies by location and plan type. We would confirm in writing how this program is funded for the group and whether any fee applies.
Where it fits in plan design
It sits in the care management layer, above wellness and coaching, for members with higher needs. It is most relevant to groups that want clinical outreach on emerging high-cost claimants, and it works best with a stable claims data feed.
What to settle before relying on it.
How does Cigna find rising-risk members?
We would ask what data feeds the predictive model, how often it runs and how members are approached, so we understand outreach limits.
What does the employer receive in reporting?
We would ask for the participation and engagement reporting available, at what group size, and how privacy limits detail.
What is the cost and how is value measured?
The page states a goal of better outcomes and savings but no figures. We would ask how Cigna measures value, over what period and with what baseline, before relying on it.
Common questions about this program.
What is Health Matters Care Management?
Cigna describes it as a program using clinical expertise and predictive modeling to identify rising-risk customers and support those with complex conditions.
Does the page promise savings?
It says the program is designed to deliver better outcomes and savings, but it gives no numbers. We would ask Cigna for the basis.
Is it included in every plan?
Not stated. Cigna says availability varies by plan type and location.
Where these details come from.
This page summarizes what Cigna publishes. Programs change, so confirm current details with the carrier before relying on them.
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Contribution split by tier
Enrolled counts by tier
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