New AI-enabled capabilities and predictive insights will help more customers connect with personalized support from experienced clinicians earlier in their health journey. This can make it easier to navigate complex health needs, coordinate care, and access resources available through their health plan.
At a glance
- Cigna Healthcare is expanding its care management capabilities to help connect 20% more customers with emerging, complex, chronic, or behavioral health needs to personalized clinical support.
- More than 1,250 clinicians, including nurse case managers and behavioral health specialists, provide guidance and care coordination.
- New AI-enabled capabilities and predictive analytics help identify opportunities to offer support earlier.
- Customers can connect with clinicians through phone, text, email, and digital tools.
- Among customers identified through Cigna Healthcare’s avoidable inpatient predictive model who engaged early with care management support, inpatient stays were reduced by 42%.1
- Existing programs have also been associated with earlier identification of likely breast, colorectal, and lung cancer diagnoses.2
When someone is diagnosed with a serious illness, managing a chronic condition, or facing a complicated health situation, knowing where to start can be overwhelming. Questions about treatment, benefits, and next steps can add stress to an already challenging time.
Cigna Healthcare is expanding its care management capabilities to help more customers access personalized clinical support earlier in their health journey. New AI-enabled capabilities help identify customers who may benefit from outreach sooner, while more than 1,250 experienced clinicians – including nurse case managers and behavioral health specialists – provide guidance, care coordination, and support for people with complex health needs.
What does this mean for customers and families? Who is eligible, how does the program work, and what role does AI play?
The following FAQ answers some of the most common questions.
What is Cigna Healthcare announcing?
Cigna Healthcare is expanding its care management capabilities to help identify customers who may benefit from clinical support earlier in their health journey. New AI-enabled capabilities and predictive analytics are expected to help connect 20% more customers with emerging, complex, chronic, or behavioral health needs to personalized care management support.
Historically, some support programs have intervened after a diagnosis, hospitalization, or another significant health event. These enhanced capabilities help create opportunities to engage more customers sooner and help them access available support before health challenges become more difficult to manage.
What is care management?
Cigna Healthcare’s care management programs connect customers with emerging, complex, chronic, or behavioral health needs to experienced clinicians, including nurse case managers and behavioral health specialists, who help them understand their care options, coordinate care among providers, and access resources available through their health plan.
These clinicians do not replace doctors or specialists. Instead, they help customers navigate the health care system, understand available support, and make informed decisions throughout their care journey. Cigna Healthcare care managers may also work with a customer’s doctor and other members of the care team to help coordinate care, share relevant information, and support a more integrated care plan that addresses the customer’s needs and treatment goals.
Who qualifies for care management?
Cigna Healthcare identifies customers who may benefit from care management support based on their individual health needs, clinical circumstances, and health plan benefits.
For example, customers with chronic or complex health conditions, including cancer, heart disease, stroke, kidney disease, high-risk pregnancy, and behavioral health conditions, may be identified as candidates for additional support. Eligibility and available services vary by health plan.
How can a nurse case manager or clinician help?
Navigating a serious diagnosis or complex condition can feel overwhelming. Cigna Healthcare’s care management programs provide customers with a dedicated clinical resource who can help answer questions, coordinate care, connect them with available resources, and provide support throughout their health journey.
Depending on a customer’s needs, support may include help such as:
- Understanding treatment options, medications, and next steps
- Coordinating care among multiple providers
- Identifying programs and resources available through the health plan
- Facilitating access to medical and behavioral health services
- Navigating complex health situations and care decisions
The goal is to help customers get the right support at the right time and feel more confident managing their health.
Why does earlier support matter?
Many people do not receive additional support until after a hospitalization, diagnosis, or another significant health event. Early clinical engagement can help customers better understand their treatment options, address care gaps, coordinate treatment, and connect with quality network providers and available support services for better management of health issues.
These new enhancements build on Cigna Healthcare’s ongoing efforts to connect customers with earlier support for cancer and other health needs, including potentially high-risk pregnancies that could result in a neonatal intensive care unit (NICU) stay after birth.
Among customers identified through Cigna Healthcare’s avoidable inpatient predictive model who engaged early with care management support, inpatient stays were reduced by 42%.1 Existing programs have also been associated with earlier identification of likely breast, colorectal, and lung cancer diagnoses.2
How does Cigna Healthcare identify customers who may need support?
Cigna Healthcare uses predictive models, along with AI-enabled capabilities and analytics, to help identify patterns that may indicate a customer could benefit from additional clinical support. These insights can help highlight emerging health risks, care gaps, or complex situations where earlier outreach may be beneficial to the customer.
For example, Cigna Healthcare may use information such as behavioral health diagnoses, prescription fills, searches for behavioral health conditions through myCigna, and other signals to identify customers who may benefit from behavioral health support. When appropriate, we can proactively reach out to those customers to discuss available support and help connect them with behavioral health providers who specialize in their condition and align with their individual preferences. Customers may also be directed to educational resources and digital tools that support their needs.
The purpose is not to diagnose a condition or make treatment decisions. Instead, these tools help identify opportunities for support, enabling Cigna Healthcare’s clinical teams to connect with customers earlier and prioritize outreach where it may have the greatest impact.
What conditions are supported through care management?
Cigna Healthcare’s expanded care management capabilities are designed to identify and support customers with a variety of emerging, chronic, and complex health needs, including:
- Cancer
- Heart disease
- Stroke
- Kidney disease
- High-risk pregnancy
- Behavioral health conditions
Support is personalized based on each customer’s individual needs and situation.
How is AI being used in Cigna Healthcare’s clinical support programs?
Cigna Healthcare uses AI-enabled capabilities and predictive analytics to help identify customers who may benefit from additional support. These tools can help detect emerging health needs, personalize outreach, and identify opportunities to connect customers with experienced clinicians earlier in their health journey.
The goal is to help create more opportunities to engage customers with our clinicians before a condition becomes more serious and to make it easier for them to access available support and resources.
Does Cigna Healthcare use AI to make health care decisions?
No. AI-enabled capabilities are used to identify opportunities for outreach and support, but they do not replace medical advice, diagnose conditions, or determine a customer’s course of treatment. Health care decisions continue to be made by customers and their health care providers.
The purpose of the technology is to help identify customers who may benefit from additional guidance and care coordination, while providing Cigna Healthcare nurse case managers and clinicians with additional insights to help personalize the support they provide.
What role do clinicians play alongside these AI-enabled capabilities?
Experienced clinicians remain at the center of Cigna Healthcare’s care management programs. AI-enabled capabilities help identify and prioritize opportunities for engagement, while clinicians provide the personalized guidance, care coordination, and expertise customers need to navigate complex health situations.
More than 1,250 Cigna Healthcare clinicians, including nurses and behavioral health specialists, work directly with customers to answer questions, coordinate care, explain available resources, and help people understand their care options.
How do customers connect with a case manager or clinician?
Cigna Healthcare customers who are identified as potentially benefiting from care management support may be contacted by a Cigna Healthcare clinician and invited to participate.
Once enrolled, customers can engage through the communication method that works best for them, including:
- Phone
- Text
- Digital tools
The experience is designed to make it easier for customers to stay connected and receive support in the way they prefer.
What results have Cigna Healthcare’s care management programs achieved?
Among customers who engage with existing care management programs, Cigna Healthcare has reported:
- 95% customer satisfaction among surveyed customers3
- Earlier identification of likely breast, colorectal, and lung cancer diagnoses by approximately 55, 46, and 37 days, respectively2
- Clinically meaningful improvement in depression symptoms for 72% of customers connected with behavioral health providers4
These results highlight the potential impact of connecting more Cigna Healthcare customers with experienced clinical support earlier in their health journey.
How can these enhancements benefit employers?
When employees are facing serious or complex health challenges, navigating care can be time-consuming and overwhelming.
Earlier access to clinical guidance and care coordination can help employees better understand their options, connect with available resources, and spend less time managing the complexities of care on their own.
For customers who engage with care management programs, Cigna Healthcare has reported improved outcomes and reductions in avoidable inpatient stays. As the program enhancements are implemented, employers may see improvements in employee health outcomes that can help reduce the need for high-cost care over time.
Related resources
- Results based on a Cigna Healthcare 2025 study on the avoidable inpatient predictive model where customers met goals within the complex case management program. Results may vary.
- Results based on a Cigna Healthcare 2025 study of Cigna Healthcare customers with a new cancer diagnosis identified for Oncology Case Management between September 2023 and September 2024, and with a case opened within 180 days of diagnosis. Results may vary.
- Cigna Healthcare case management national participation satisfaction survey results, 2025.
- Based on a Cigna Healthcare 2026 study of data submitted by Evernorth Behavioral Care Group Core providers for customers with an intake date between August 20, 2025, and December 31, 2025, and baseline PHQ/GAD scores of 10 or higher. Symptom reduction calculated as the difference between the most recent score and the intake score. Results may vary.