4 min read July 2023 — In an interview with Invest:, Tim Vessel, market growth leader for South Texas and Louisiana at Cigna Healthcare, talked about the state of the health insurance industry and strategies to improve access to healthcare for underserved communities. The industry faces challenges in terms of cost and access but there are opportunities for improvement, he said.
What is your analysis of the health insurance industry?
It has both challenges and opportunities. The main challenge is that access to care and cost of receiving healthcare services are high-cost elements for all businesses and individuals. Health care is essential, no matter the industry or the stage of life. We recognize that disparities in healthcare are real and we have been focusing on improving services for underserved communities for a long time.
We know that the rising cost of care remains a major pain point for our industry. Prior to COVID-19, we delivered medical trends at or below the consumer price index (CPI) for nearly 50% of clients who leverage our more innovative integrated solutions. Today, we are approaching affordability with added intensity. We are solving for this through things like value-based care arrangements, addressing factors that impact social determinants of health (things like food, transportation, safe living conditions and education) and driving volume to high-performing providers.
What are some strategies you have implemented to bring down access barriers?
This is a massive issue because, without access to preventive care, underserved communities are unable to benefit from earlier interventions for chronic conditions to prevent them from worsening over time. We think it is critical to recognize those disparities and have conducted several studies to identify areas across the country where they exist. We have partnered with other players in the healthcare delivery system to evaluate the solutions and resources that can be implemented in the community. For the employers we insure, we can perform an analysis based on population distribution and identify pockets in their employee population where disparities exist. We then partner with them to address those issues as well.
We also reward value-based providers to screen for social needs, make appropriate referrals, identify health disparities impacting their patient population, and develop an action plan. Throughout the pandemic, our value-based programs did not remain stagnant. We made those necessary shifts in growth expectations through COVID and beyond.
We take social determinants of health very seriously and they are something we are committed to continuing working on for the benefit of clients and customers.
Have you noticed any shifts in demand for your services?
The biggest shift we have seen centers around virtual care. We have always had the capability to provide virtual care, but the uptake was low. Today that usage is around 75% or 76% and we think that trend will continue. We believe that in the next few years one out of every three healthcare interactions will be carried out virtually because it is a time efficient, convenient and cost-effective way of working.
Thanks to our acquisition of MDLIVE – which significantly expanded our virtual care network of providers – we offer urgent care, primary care, behavioral, dermatology, dental and acute and chronic condition support.
In early 2022, the Cigna Health Plan significantly expanded access to covered virtual care services for millions of customers enrolled in employer-sponsored plans. The integrated services are delivered through MDLIVE’s network of virtual primary care providers and include primary, dermatology, behavioral, and urgent care. Cigna also offers virtual-first health plans to select employers. These innovative plans include $0 copays with MDLIVE primary care providers, comprehensive chronic condition management and care navigation, and no referral requirements for in-person visits with in-network health care providers.
This isn’t just about convenience – it’s more affordable. For example, with virtual care our customers and their employers see a $1,490 savings compared with avoidable ER visits.
How do you think healthcare can be made more cost-effective?
We have to empower our customers to understand their own healthcare status and take ownership of their own journeys. This is the way to improve the long-term cost of healthcare. We provide individuals with the information, tools and resources they need to manage their personal healthcare situation whether that is preventive care or an individual dealing with chronic conditions. We also think it is critical we partner with the healthcare delivery system in a collaborative way so sharing information is crucial to get a full view of someone’s health journey.
The other important thing is our focus on value-based care. We align incentives with healthcare delivery systems in a way that provides financial incentives to improve the underlying health of the population served. We think that by improving the underlying population of individuals, collaborating with the healthcare delivery system and working with employers to help them develop health improvement strategies, we can positively impact the population and over time mitigate the cost of healthcare. We have already seen success with employers that have embraced that approach.
What are some trends impacting the industry now?
A positive trend is the increase in the demand and adoption of virtual care. Our customers recognize the convenience of accessing care from their smartphones or computers wherever, whenever they need it without having to spend time in traffic or sitting in the doctor’s waiting room.
Unfortunately, we are also seeing an increase in the cost of pharmacy medications and some gene therapies that address serious health conditions. And for this reason, we’ve come up with Cigna Copay Assurance plan, a new solution to help provide predictability to customers for traditional and specialty medications. This program was developed for clients interested in lowering customer costs and providing better predictability for their customers at point-of-sale. This plan offers low flat-dollar copay tiers for traditional and specialty medications. Customers will know exactly what they will be paying for medications leading to increased adherence and total plan cost savings.
Beyond that, I think it is important we continue to understand and recognize the connection between physical and mental health as that has become more prevalent in today’s world. As I mentioned, we have added a social determinant of health consideration in physician interactions to find out what is impacting circumstances from a mental standpoint.
What is your outlook for the near term for Cigna?
Our outlook is positive – and we are excited about where we are as an organization and about what we can deliver to our customers and clients. We look forward to continuing our journey to positively improve the underlying health of the community we serve. We also want to continue focusing on delivering value to our clients so they can achieve their objectives as an organization. We want to deliver solutions that improve the health of their employee population, which will increase productivity for our clients. We are excited to continue doing that and continuing to serve our partners.
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