By The California Applicants’ Attorneys Association | May 13, 2024

In this article published on April 29, ProPublica delves into the experiences of Dr. Debby Day during her tenure as a medical director at Cigna Health.  Dr. Day’s story unfolds as Cigna institutes the use of productivity dashboards for their doctors.

Productivity dashboards track how much time Medical Directors spend reviewing cases. The metrics produced by the dashboard play a large role in performance evaluations and compensation. Despite Dr. Day’s concerns about the implications of prioritizing speed over accuracy, she faced pressure from upper management to increase her productivity score. This story was reported after Cigna was hit with a lawsuit over allegations that its doctors use an algorithmic system to automate mass denials of coverage. The insurer’s doctors spent an average of just 1.2 seconds on each of those cases.

Dr. Day’s dedication to ensuring the accuracy and appropriateness of medical decisions clashed with Cigna’s emphasis on productivity metrics. She encountered challenges with the quality of case files prepared by nurses, particularly those from overseas, which contained errors that could lead to unjustified denials of coverage. Dr. Day’s meticulous approach to reviewing cases often resulted in slower decision-making compared to her peers, who sometimes opted for quicker denials to meet quotas and receive bonuses.

Throughout her tenure, Day advocated for a balance between efficiency and quality in healthcare decision-making. However, she was unsupported by management, who focused solely on improving her productivity score rather than addressing the underlying issues with the company’s approach. Despite her efforts to raise concerns internally, Day ultimately decided to retire from Cigna due to the stress and mental toll of the job.

Overall, the article sheds light on the complex dynamics within the healthcare industry, where the pursuit of efficiency and cost savings can overshadow the importance of ensuring high-quality patient care. If these productivity metrics and algorithm-based-blanket denials are happening in the Healthcare industry, we can also understand that this is what’s happening within the workers’ compensation system with how “evidence based medicine” is used to support denials of medical treatment.