Inside Cigna Subsidiary Evernorth’s Plans to Leverage Data to Identify At-Risk Members

Behavioral health remains a primary focus for Cigna Corp. (NYSE: CI) as it and its services arm Evernorth continue to address the growing demand for behavioral health services.

Evernorth behavioral health network has doubled over the last five years, the company revealed last week in its second-quarter earnings call.

In a recent interview, Dr. Doug Nemecek, Evernorth’s chief medical officer for behavioral health, told Behavioral Health Business that the network presently includes more than 250,000 providers.

A psychiatrist by training, Nemecek said that Evernorth seeks to fill the gaps in behavioral health specifically — and anywhere it can in health care generally — with all of the capabilities that Cigna can offer. But if it can’t, it will find innovative partners to join in the effort.

In 2020 Evernorth inked a deal with Quit Genius, a digital health clinic that treats addiction, in order to make the product available to its members. Last year, Evernorth partnered with Alma, a business service platform for independent mental health practitioners.

This interview was edited for style, clarity and length.

What is Evernorth? And how does Evernorth interact with the behavioral health space? 

Evernorth is the health services arm for Cigna. We are able to bring our capabilities around data and analytics, deep clinical expertise across medical and behavioral health (which I’m most involved with) and the pharmacy areas together in a coordinated way.

What health care services are we talking about specifically?

We have a vast capability of innovative services across Evernorth. That includes things like pharmacy services — the ExpressScripts brand and some of the other pharmacy management companies that exist through their specialty pharmacy, etc.

We have capabilities to manage behavioral health from a benefits perspective and also to provide care.

There is a part of Evernorth that’s called Care + that is all about delivering care. We’ve got MDLive, a virtual care platform that provides virtual care access across the United States. We have Direct Care which provides on-site health care. It partners with employers and other communities to bring health care closer to the consumer.

Part of Evernorth really focuses on analytic and data capabilities. Being born from Cigna and having these awesome capabilities like ExpressScripts and behavioral health, we have a lot of data. [We] have an ability to coordinate that, integrate it holistically, create algorithms and do the analytics that allows us to address diverse client needs.

Who are Evernorth’s clients?

Our clients can include a vast array of employer clients, other health plans, the government — the full spectrum of entities who are providing care and delivering care services.

It’s interesting to hear Evernorth talk about providing services to other health plans. It seems like these types of services would ultimately enable competition against Cigna. Am I thinking about that the right way?

Everybody has gaps or needs [and is] looking for solutions that can do something better. Evernorth comes into play when we can help other health plans or employers or other government agencies fill the gaps.

That might be in the case of an MDLive type of solution to help bring them additional virtual care capabilities that they don’t have within their networks.

From a behavioral health perspective, sometimes it’s bringing in our robust networks, managers, and clinicians focused on autism.

The other piece of that we’re doing as we bring Evernorth together, we create new, unique solutions — especially in my world of behavioral health and pharmacy — in ways that other health plans don’t have the ability [to do].

What are the areas within behavioral health that you see Evernorth doing the most work?

There’s a huge need for more access to care and quality access in behavioral health as well [leveraging] data and analytics to identify and find people who need help.

Because of the pandemic, there’s been a 25% increase in the number of people reaching out trying to search for behavioral health support. But there’s a shortage of providers. There’s stigma. People don’t understand the behavioral health ecosystem.

We have the ability to leverage our data and analytics to identify people sooner and engage them in the right direction to get their needs met and provide better access to care, to make the behavioral health journey simple.

[Then we], ultimately, track outcomes along that journey so that we can truly demonstrate that the behavioral health care for that individual, as well as across populations, is improving and people are truly getting the care that they need and getting the outcomes that they desire.

You mentioned the provider shortage. How does Evernorth deal with something so big and intractable as that? 

Across Evernorth today, we have a network that includes 250,000+ behavioral health providers that are practicing virtually and in offices across the United States. That’s not enough to meet everyone’s needs. Then [the question] becomes how do we expand that network in new and innovative ways?

One of the things that we’ve done is to look at how [to] start to bring in coaches, and peer supports and other levels of professionals that can help meet the needs for individuals with mild and sub-therapeutic issues like stress so that those individuals don’t take up a therapy appointment that somebody else who needs that therapist [might need].

Another way [to grow the network] is through the expansion of digital care. I think one of the silver linings from the pandemic has been the level of comfort that both providers and patients have developed with virtual care, especially for behavioral health.

We quickly went to 60% of outpatient behavioral health visits being delivered virtually. Today … we still see 50% to 60% of our outpatient visits being delivered virtually.

The other way is to find other innovative partners that are starting to develop new, innovative ways of delivering care. Again, the pandemic has really accelerated this. We now have partners that are delivering substance use disorder care virtually and able to do that at scale. We’ve got innovative programs treating eating disorders virtually and allowing people to get care in their homes in new and innovative ways.

We’re also really focused on measuring and demonstrating how people could get into care quickly. I’m sure we’ve all heard stories of people who say [they can’t] get an appointment for a month or two months or longer. We’re now [asking] how we can make it so that this is no longer the case.

What does leveraging data to find members in need look like?

It’s about looking across our medical data, behavioral data and pharmacy data and integrating it into models that help us identify people who have behavioral health needs and get them into the right care sooner.

We’ve got a predictive model now that identifies children who are more likely to get diagnosed with autism in the next six months. They’re not diagnosed yet. But we can look at the claims from their pediatrician and other things going on in their life and say, “Hey, we see this pattern and know that when this happens, this child is at high risk to be diagnosed with autism.”

In doing that, we can engage the pediatrician [and the] parents and get that child to the right place to see if they have that diagnosis and, if so, get them started on a care app to address autism sooner.

Another example is around … [identifying] individuals who are at high risk of overdosing in the next 30 days. We can engage our case managers and clinicians to reach out to … the individual to engage their support [network], [find out what’s going on], and make sure they get the right type of care — whether that substance use disorder care, medical care for a chronic pain condition, whatever it is.

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