Case Study: How Cigna is Transforming Health Insurance and Patient Care with AI

Background

Cigna, a Fortune 15 global healthcare and insurance company founded in 1982, operates with a workforce of over 70,000 and caters to more than 175 million customers. With a diversified portfolio offering health, life, accident insurance, and Medicare and Medicaid products, Cigna reported an adjusted income from operations of $7.3 billion in 2022, marking an increase from the previous year. Their revenue stood at a substantial $180.5 billion. Cigna’s adoption of AI across various facets of its operations has been central to its strategy to enhance customer and employee experiences.

Key Takeaways

  • Cigna uses AI to streamline claim payouts through a rules-based system, ensuring HIPAA compliance and operational efficiency.
  • Predictive analytics employed by Cigna’s subsidiary, Evernorth, aids in early detection and management of chronic conditions, improving patient outcomes.
  • AI-powered internal talent management systems help Cigna in employee retention by recommending roles aligned with their skills, resulting in 65% of roles being filled internally post-implementation.
  • Cigna’s partnership with Infermedica has led to the development of a symptom-checking app that acts as a triage tool, potentially improving pre-visit diagnoses and optimizing healthcare delivery.

Deep Dive

Approach

Cigna’s approach to AI integration has been methodical and customer-centric, targeting key operational areas to maximize impact. The approach was not to apply AI technologies indiscriminately but to identify areas where AI could provide the most significant benefits—both in terms of customer satisfaction and operational efficiency. This led to the adoption of AI in claims processing, patient care, employee development, and diagnostic support. By partnering with specialized AI service providers, Cigna has been able to tailor AI solutions to their specific needs. These solutions range from sophisticated rule-based systems for payment eligibility to advanced predictive analytics for healthcare management. Their approach underscores a deep understanding of the potential AI holds in transforming healthcare and insurance services, and a strategic vision to implement this technology where it can add real value.

Implementation

Cigna’s implementation of AI in their operations exemplifies their commitment to innovation and efficiency. In the realm of claims processing, Cigna adopted a business rules management system (BRMS) through their partnership with Progress Corticon. This system automated the decision-making process, enabling Cigna to process claims more efficiently and with greater accuracy. By establishing a set of rules that take into account factors such as coverage, medical procedures, and the claimants, Corticon’s system improved the speed and reliability of determining customer payment eligibility, reflecting a modernized, agile approach to claims management.

In the field of healthcare management, Cigna, through its subsidiary Evernorth, has harnessed the power of predictive analytics to address chronic conditions. Utilizing machine learning algorithms, they can now predict such conditions before their onset, allowing for proactive patient care. This system leverages both traditional and alternative data sources to forecast likely diagnoses, facilitating early intervention. Consequently, patients receive timely support and guidance on treatment options and insurance coverage, easing their journey through the healthcare system. This predictive outreach has notably increased patient participation in recommended clinical programs, demonstrating the effectiveness of AI in improving patient outcomes.

On the internal front, Cigna’s revamping of their talent management system illustrates a strategic application of AI to human resources. By employing the Phenom platform, Cigna has been able to better align employee skills and interests with available opportunities within the company. The AI-driven system analyzes employee data, such as strengths, skills, and career aspirations, to suggest suitable internal job positions. This not only aids in talent retention but also capitalizes on the potential of existing employees, fostering a more dynamic and engaged workforce. The result has been a marked improvement in internal recruitment, with a significant percentage of open roles being filled internally, which speaks to the success of this initiative.

Results

The results of Cigna’s AI initiatives reflect a transformative impact on both the customer experience and internal processes. The deployment of the BRMS for claims processing not only centralized and streamlined operations but also increased the accuracy of claim assessments, leading to a more efficient routing process and reduced maintenance costs. In patient healthcare management, the use of AI for predictive analytics has substantially increased patient engagement with clinical programs, indicating that patients are benefiting from the early detection and management of their conditions. Internally, the AI-powered talent management system has proven to be a significant asset, with Cigna filling the majority of open roles from within the company, reducing the costs associated with external hiring and training. These results showcase the tangible benefits of AI in improving operational efficiency, enhancing customer service, and empowering employees, thereby reinforcing Cigna’s reputation as a leader in technological innovation in the healthcare industry.

Challenges and Barriers

Cigna’s journey hasn’t been devoid of challenges. The implementation of the PXDX computer algorithm led to a federal lawsuit with allegations of claims being rejected without proper review. Balancing automation with human oversight remains a critical challenge for the company.

Future Outlook

Cigna’s commitment to leveraging AI demonstrates a forward-thinking mindset, aiming to enhance healthcare services while also optimizing internal operations. The company’s future endeavors will likely continue to integrate AI deeper into its processes, overcoming challenges and setting a precedent in the healthcare industry for innovative technology adoption.

Sources:
Artificial Intelligence at Cigna – Four Use Cases
How Cigna used AI to revamp its internal recruiting system


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