The US healthcare system is facing complex challenges to affordability and access. In this episode of the McKinsey on Healthcare podcast, McKinsey Senior Partner Celia Huber is joined by Brian Evanko, president and COO of The Cigna Group. As COO, Evanko oversees all of the company’s businesses within its two growth platforms: Cigna Healthcare (for health benefits) and Evernorth (for health services).
In his 27 years with the company, Evanko has seen significant change in the healthcare landscape, including growth in targeted medications for rare diseases, the introduction of the Affordable Care Act, the COVID-19 pandemic, and the rise of GLP-1s. Through every major shift, rising costs have remained a challenge, especially in chronic-disease management. Below, Evanko shares his perspective on the innovation needed, including the adoption of AI, to drive sustainable change in healthcare.
A condensed version of the conversation follows.
The evolution of the healthcare industry
Celia Huber: How has the healthcare industry evolved during your career at The Cigna Group?
Brian Evanko: The industry has changed tremendously over the 27 years that I’ve been at The Cigna Group. When you step back and think about the benefits to society, there’s been a tremendous amount of innovation across healthcare, from devices to pharmaceuticals. For example, robots can now conduct surgeries with assistance from doctors, there are cures for diseases that we didn’t think were possible in the past, and, more recently, GLP-1s are having a beneficial impact on society.
The converse of all that is affordability. Affordability is problem number one in the US healthcare system. Back in 2000, healthcare was about 13 percent of US GDP. Now, it’s about 18 percent.1 High-cost prescription drugs are a major part of the problem: While only 10 percent of all prescription drugs in the United States are brand-name medicines, they represent a startling 88 percent of the spending.2
Celia Huber: As you look forward, what major changes do you anticipate in the healthcare space?
Brian Evanko: Many aspects are ripe for change. One is prescription drug innovation—using biosimilars, generics, and the power of competition to drive costs down.
Second, consumers have growing expectations for their experiences across all industries. And the healthcare industry has a long way to go in that regard. We see a future where technology, advanced analytics, and AI will lead to a more personalized healthcare experience for individuals.
It all starts with understanding individuals and subsegments of populations to make sure our solutions are appropriate not for averages, but for an individual’s needs. And a big part of that is making sure people have the right information at the right time. We see people making choices that are not financially optimal or opting into unnecessary care. For example, if someone needs a knee replacement, that’s an elective procedure; they’re able to take their time deciding when and where that procedure transpires, what doctor performs it, and what the follow-up routine is. We have an opportunity to provide the patient with all the information they need to make those decisions. We’re especially excited about our new model for pharmacy benefits, which will lower costs for consumers directly at the pharmacy counter and apply to their deductible. It brings together the understanding of the needs of consumers with innovation to lower costs and create a more seamless consumer experience.
Improving patient care journeys
Celia Huber: What opportunities do you see for improving the care journey for your members through partnership and collaboration as well as site of care?
Brian Evanko: Partnership is a hallmark of our company strategy. We don’t own physician groups, hospitals, or surgical centers because we believe that being a partner to providers leads to better outcomes. Providers don’t feel like we’re competing with them, and we can supply them with all the clinical data and information for patients to support the best outcomes for every individual.
Similarly, in our Evernorth business, we partner very closely with health systems and hospitals to help them run their in-house pharmacies—such as supporting inventory management or coordinating care across different settings—because the patient is only in their hospital or health system temporarily.
In terms of sites of care, telehealth became more common in the pandemic, but it wasn’t a temporary phenomenon. The level of care through our virtual platform, MD Live, is much higher now than it was pre-pandemic on a sustained basis. And we found that people like to interact virtually with their doctors in a lot of cases. For parents, helping their child get care quickly in their own home for less complex conditions, such as the flu or pink eye, is a game-changer.
Last, through our specialty pharmacy business, we have about 600 home infusion nurses3 who travel to the homes of people who require complex, clinically intensive specialty medications, such as individuals with cancer. This is critical for patients so that they don’t have to travel to an infusion center or hospital to receive care.
Celia Huber: How do you see the role of the health insurer evolving, and are there urgent challenges that health insurers need to address?
Brian Evanko: Over the past year, there’s been a rise in public scrutiny around trust with health insurers. We don’t resist this fact, and we spent a lot of time listening to understand the reasons behind that distrust and taking action.
We see two real opportunities in the face of these challenges. One is to focus on being an advocate to those we serve through our health insurance business: helping individuals and employers navigate the complexity.
The other is to work toward a system that works for everybody, and not just for most people. Imagine if the person in need of care and support is your friend or a family member. While most people are satisfied with their health benefits, cases that are the most complicated are often the ones we need to put additional resources behind.
To do these things, insurers need to get better at listening to make sure we really understand what our patients are feeling. It goes beyond call centers. Insurers should be listening to social media and focus groups as well as provider partners to hear what they’re experiencing, too.
Pursuing innovation and harnessing technology
Celia Huber: How are you thinking about innovation across the organization? What investments are you making?
Brian Evanko: Innovation requires intentionality. The overall space is ripe for innovation through technology—to improve care journeys and patient experiences. At Cigna Healthcare, we’ve been focused on our mobile app and making it as intuitive as possible. This has included introducing an AI-powered virtual assistant, which allows people to get answers to many of their questions in real time without having to make a phone call.
At Evernorth, we’ve introduced a variety of programs over the past 18 months that are focused on providing access to GLP-1s at an affordable price and in a way that ensures patient safety. For example, we have a program that caps patient out-of-pocket costs at $200 per month for these very expensive drugs.4
Finally, in our specialty pharmacy, we’ve been focused on AI use cases for unstructured data. When a prescription is written for a high-cost, clinically intensive specialty medication, we need to make sure it’s appropriate before it’s actually dispensed. With AI, we’ve been able to process this data more quickly, reducing the amount of time between when the prescription is written to when we can send it out from several days to within a single day.
Celia Huber: How are you deciding what technologies to explore? Are there transformative technologies you’re most excited about for their potential impact on insurance operations and experiences for members?
Brian Evanko: Certainly, advanced analytics and AI could potentially bring breakthroughs. We look at potential applications of transformative technologies through the lens of “Is it foundational, is it strategic, or is it disruptive?” And then we ask questions like, “Is it in support of stakeholder experience improvements or lowering costs?” Specifically, much of our investments to date have gone toward reducing foundational operating expenses.
In the future, we aim to make more strategic and disruptive investments focused on stakeholder experience improvements through advanced analytics and AI. Ultimately, we expect the US system to be much more focused on upstream preventive care—where diagnostics are used for early detection and patients feel more empowered to take control of their own healthcare. For example, AI-supported full-body scanners may be able to detect cancers sooner than traditional medical technology has been able to do.
Today, 90 percent of spending in the US healthcare system is for chronic care.5 That’s what I call a “sick care” system. We need to harness technology and AI upstream to shape a more effective, more sustainable system.
Of course, you have to be thoughtful about AI when medical data is involved. It’s not about meeting regulatory requirements but ensuring that predictive models are equitable and that we always have a human involved in care decisions. We will continue to move methodically in applying these capabilities to clinical applications to ensure there’s no bias and to protect the trust of the patients we serve.
Cultivating the next generation of leaders
Celia Huber: What values have shaped your approach to leadership, and how do you think about cultivating the next generation of leaders?
Brian Evanko: At this moment of significant change, it’s critical for leaders to have a learning orientation, to read feverishly and be a sponge for information. I call it confident humility—knowing you don’t know everything yet having the confidence to make decisive choices on behalf of the organization and always being guided by clarity of purpose.
Relatedly, we must create an environment where everyone can contribute at their highest level. We’re proud of our legacy of leadership development programs and continue to invest in those programs. Today, we look for people for these programs who can apply technology effectively, who have a systems-design mindset. They could be actuaries or data scientists or from finance, but they’re able to apply technology to the biggest problems in healthcare. Clinicians are also more important than ever, as are experts in communications and government affairs in the healthcare space. So our development efforts focus on these young leaders, providing them structured programs and, in some cases, on-the-job training to make them the best in their craft so we can continue to be the best in ours.
