There’s no question that the U.S. health care system is complex. According to a survey by Accenture, more than half of U.S. consumers don’t understand how to navigate the current health care landscape because of its complexity. This can negatively affect health outcomes for people, impact coordination of care, and contribute to higher health care costs.

One way Cigna is working to simplify this complexity is by harnessing the power of data and advanced analytics.

Sachin Joshi, chief data and analytics engineering officer at Evernorth, Cigna Corporation’s health services business, recently sat down for a fireside chat at the VentureBeat Transform 2022 conference. Speaking with Jana Eggers, CEO of Nara Logics, Joshi discussed the ways Cigna is using data science, predictive modeling, and machine learning to improve patient health outcomes, reduce costs, and fix a fragmented health care system. You can watch their full discussion below or keep reading for some of the key takeaways. 

Unpacking Complexity Within the Health Care System

The number one cause for complexity in health care is fragmentation, according to Joshi. For example, patients with one or more chronic diseases often need care from a wide range of different medical professionals, which can sometimes feel disconnected for consumers when getting lab work done, visiting a primary care physician, seeing a specialist, or getting prescriptions filled.

Joshi’s team at Evernorth saw an important opportunity to pull together this data and better coordinate care. They created a digital platform called Health Connect 360, which employs data science, predictive modeling, and machine learning to improve patient health outcomes and lower costs. The platform harnesses data across the full spectrum of health channels, from medical, pharmaceutical, third-party, claims, and digital devices.

Using this data, the platform automatically identifies opportunities requiring clinical attention — which allows Evernorth to custom-tailor interventions to a patient’s clinical condition and engagement preferences. It can also inform proactive, preventive outreach, which leads to better health outcomes and lower costs for customers.

For instance, we can help patients with diabetes who don’t take their medications as prescribed become adherent. The platform also helps employers better understand their health care costs from a macro level, providing a dashboard with a 360-degree view of beneficiary activity and costs.

Creating a Data-Driven, Outcomes-Based Approach

Joshi highlighted an important shift toward an outcomes-based approach that focuses on meaningful clinical health care outcomes, rather than just activity  — working with clients to establish clinical goals that meet their needs and focusing on areas that can help save them money.  

“The key is to not try to develop a one-size-fits-all solution to health care, but rather to create a customized approach for each customer,” Joshi said. This allows clients to work with us to measure the cost, value, and outcomes related to health care. Joshi explained that different industries have different employee profiles and health care issues. Chronic illnesses such as diabetes or heart disease and behavioral issues like depression are ubiquitous. However, each may be more or less prevalent within different employee populations — along with the levels of support that may be required.

According to Joshi, the data-driven Health Connect 360 platform is making an impact on individual customers. For example, he pointed to the high cost of prescription drugs — one in eight Americans say the high cost of prescription drugs causes them to skip doses or delay refilling prescriptions. Joshi described how Evernorth’s outreach team helped lower customer’s prescription drug costs. For some diabetes patients, the platform was able to identify cases where people were under-ordering insulin because they thought they couldn’t afford to order the correct amount. Evernorth’s outreach team was able to walk them through ways to lower their costs by switching to generics. “I was struck by the gratitude and emotional response from our customers,” he said. “This validation of the mission helps inspire our team to keep iterating and improving the experience for our customers.”

How to Get More Power out of Data

For other industry or tech professionals who may be facing similar data fragmentation challenges, Joshi had three pieces of advice.  

“First and foremost,” he said, “it’s important to start with the experience you are trying to deliver for your customers. Ask yourself, ‘Are we delivering something of value to our customers and clients?’ It’s crucial to focus on the right things. When we rolled out Health Connect 360, the data and the predictive models were the most important things for us.”

His second piece of advice is to focus on progress over perfection. When it comes to emerging technologies or a new product, “don’t let perfect be the enemy of the good.” Constantly iterate toward those tasks that will deliver the most value.

Finally, Joshi said, “It’s OK to be vulnerable. Not every idea is going to be a home run, admit when things aren’t working and need to improve, to constantly get better and iterate. Testing and learning is key."