James Day, General Manager & Market Growth Leader – Carolinas, Cigna

James Day, Cigna Healthcare general manager and market growth leader for the Carolinas, spoke with Invest: about harnessing innovation and technology to provide next-level care. “Employers come to Cigna Healthcare because they see value in providing the best care, programs, tools, and resources for their employees,” Day stated. “This is a competitive talent marketplace, and employers choose Cigna to help retain talent.”

Over the last year, what shifts or developments have most influenced Cigna Healthcare’s strategy and impact across the Carolinas?

Healthcare must be more accessible and affordable. We’ve made some of the biggest advancements in our digital space, making processes like precertification and updates easier and faster for our members. We’ve provided enhancements on our advocacy and clinical side, providing one-on-one support, blending the human and digital experience with resources to help customers access care anytime. By the end of this year, we are stepping more into technology by integrating AI into all of our virtual assistants, helping members understand the claims process, and getting better access and support.

North Carolina is one of the fastest-growing states in the country, and it’s one of the fastest-growing markets for Cigna Healthcare. Technology advancements have fueled that growth. We have partnerships with Wake and Durham counties and with Duke University Health System, one of the largest health system clients for Cigna Healthcare in the country. These innovations give members access to the right information whenever and wherever they need it. 

How have Cigna Healthcare’s 2025 initiatives progressed, and what new elements have been introduced or scaled in the past year?

The Drive to 2025 investments in virtual tools and resources are strong both in Cigna and the marketplace. We enhanced our telehealth services through our acquisition of MDLIVE in 2021, which became our anchor provider for services such as alignment to a PCP. Our members have access to a full suite of virtual care options including dermatology, behavioral and urgent care. 

We are also redefining how the virtual space interacts with our members. Anytime you log into Cigna resources, it recommends a virtual and in-person option. We have virtual behavioral health, where we have seen huge advancements and growth in popularity. There is a stigma around behavioral healthcare, and many individuals are not comfortable going into a physical office. Virtual services are a gateway for individuals to access behavioral healthcare when they need it. The average American with a behavioral health condition waits 10 years to access behavioral care.

When they make the decision to talk to someone, we ensure we get them in front of an individual as quickly as possible. Our Fast Access Network provides behavioral resources and care within a matter of days, as opposed to weeks. Some individuals don’t need to sit in front of a provider; they just need coaching. Adolescent behavioral health is one of the key areas of focus where we see growth. We partner with over 16 different behavioral health vendors and guide members through their journey to find the help that is best for them. This flexibility and ingenuity are mission critical for our members. We are the only healthcare provider that has 24/7/365 live customer service. 

How has Cigna further evolved its use of data to support members and improve outcomes across the Carolinas?

One Guide is our industry-leading care navigator tool for individuals, along with our personal guide advocates. This goes back to our enhancements made around AI and transparency with our members. Individuals often feel that prior authorization is a black box, and they don’t know where their authorization sits in the process. We have a guide for members that can show, in real time, where their prior authorization is in the process.

They can see if the provider is waiting for information, if the provider has reviewed the information, and if it has been approved or denied. We guide members to exactly where their prior authorizations are in the process. We made additional investments in our One Guide model. Individuals can call in if they have a prior authorization and speak to a specialist, informing the member of next steps and timing. 

What are some of the biggest pain points for providers in your network, and how is Cigna addressing those?

One of the pervasive issues with most hospital systems is streamlining prior authorization, which is also a problem for providers. Providers don’t want to do busywork; they want to be in front of patients. One of the aspects of our prior authorization streamlining is simplifying the process for the provider to get them back to the patients. Forty percent of all prior authorizations submitted in the industry, before this year, were sent via fax.

We now have digital records going back and forth to speed up resolution for the members. We’ve also limited the number of prior authorizations needed. We work with our provider partners to decide what prior authorizations make the most sense for our members. We have embedded care coordinators, Cigna employees who reside within hospital systems, and provider groups who analyze and review all Cigna-covered members at that facility. They work in-person to figure out how Cigna-covered members can access resources, all leading to lower readmission rates, faster access to care, and higher quality of care. 

How is Cigna Healthcare collaborating with providers and policymakers to support preventive care and population health?

Preventive care is one of the benchmarks of Cigna Healthcare. We utilize tools and resources to ensure employers are incentivizing members to access preventive care visits. We provide flu shots and biometric readings. We had a team member whose blood pressure was higher than average, despite having lost weight. We sourced him back to our employee assistance line and the resources in-house to help him with his blood pressure, as well as send a note directly to his provider via MyChart, all because of the preventive visit he had in our office.

Many of our employers work with our well-being strategists, which is a unique role within Cigna Healthcare dedicated to helping employers provide the most progressive and unique benefit strategies for their population. These well-being strategists understand the culture of the organizations they partner with, how they communicate with their employees, and their preventive care offerings. They help employers tweak these things, over time, to produce the best outcomes in the industry. This role is unique to Cigna Healthcare and differentiates us from our competitors. Employers come to us because they see value in providing the best care, programs, tools, and resources for their employees. This is a competitive talent marketplace, and employers choose Cigna Healthcare to help retain talent. 

What are your top priorities for growth and impact in the Carolinas over the next two to three years?

Our top focus is on making the healthcare system more affordable as we see increases in medical and specialty pharmacy claims. We’re working to make access for individuals more apparent, virtual or in person, and providing guidance on the tools and resources our customers are demanding through innovation and technology. We have to make healthcare affordable, predictable, and simple for our members to utilize the right services at the right time.

We’re seeing innovations in the pharmacological space to drive down costs with our biosimilar strategy, targeting the highest-cost specialty medications and providing them to our members at a lower cost. We have rolled out programs that focus on GLP-1 medications, getting them into our members’ hands at an affordable cost while wrapping it with a clinical aspect so our members taking those medications are also taking measures to improve their overall health. We pair that with an individual coaching program, ensuring the member stays on a health continuum and remains on the medication.