Healthcare costs are rising, and the current COVID-19 crisis is sure to create financial hardship for both patients and healthcare facilities. Providing affordable healthcare will become even more of a priority. Digital healthcare promises to be the catalyst for reducing costs and improving patient outcomes. Cigna is leading the digital revolution in the healthcare industry. Eric Reed, Cigna SVP of Global Infrastructure Services and Application Operations, spoke at last year’s ONUG conference about the opportunities opened up by the digital transformation, as well as the challenges it brings to the healthcare industry in general. Here are the highlights of his keynote session.

Cigna’s Mission

Cigna’s mission is to improve the health, well-being and peace of mind of those they serve. Their focus on whole-person health led to the acquisition of Express Scripts last year, enabling the company to drive the whole chain of care. Cigna is deep in health services,  managing over 165 million relationships with customers and providers around the globe, and maintaining one million providers, clinics and facilities. 

Cigna knows if they can keep their patients healthy, healthcare costs will go down for both patients and employers. Everyone wins. They are achieving that goal by using targeted innovation, such as wearables, that are based on data and analytics to drive outcomes. With over 200 years of experience, Cigna has worked in the true spirit of partnership to change lives. The digital revolution is helping them achieve that mission. 

What is Driving Digital Disruption?

A move to value-based care is driving disruption, and Cigna is leading this charge by focusing on outcomes. For example, the company makes provider ratings available to customers. Much like consumers search Yelp for the best restaurant, patients can look at provider ratings, empowering them with a choice. Cigna was the first health service to have an Alexa app. Additionally, they purchased Brighter, a cloud-based platform for dental services that allows patients to see a review, read what other patients had to say, and even look at a cost index. Reed highlighted three main factors affecting digital disruption.

• Data: Collecting data is key to driving better outcomes. Patients want data on finding the best doctor at the best hospital, as well as the best treatments and tips for recovery. However, they don’t want their personal data shared.  Healthcare organizations must balance consumer privacy preferences, regulatory requirements and data gravity. Data gravity refers where data lives. Contracts or regulations often forbid personal information from leaving the country of origin. 
• Developer Enablement: Developers expect on-demand, or the ability to use hundreds of services instantly. They expect an agile, scalable infrastructure, and they don’t want to get bogged down with infrastructure plumbing. They want to focus on solutions. However, developers must also focus on designing for failure, using fault isolation techniques appropriately. Lastly, Reed focused on the need for cost awareness. Developers must know how to choose the most cost-effective tool for the job. 
• Consumer behavior and personalization: How do your customers want to be serviced? As a society, we’ve gone from looking at things on computers to mobile devices to voice-enabled devices. The trend is toward more digitization of interactions. How do you integrate devices with data based on a consumer’s preferred method of communication? Companies will have to incorporate multiple device integration, real-time analytics and the transition of data to the edge. For example, Cigna’s 75 petabytes of data is stored at this data center. It will have to move more toward the edge. “How do we do that and keep it secure?” was a vital question asked by Reed. 

Digital Adoption Is Hard

Reed acknowledged that digital adoption is hard, especially if your organization is not cloud native.  Why? Cloud native companies have legacy infrastructure already developed. A lot of innovation is happening in the hybrid world. However, for many companies, the data is still stored in their data centers. For example, Cigna’s private clouds have allowed for growth and flexibility, but data is stored on the mainframe, one of the hardest places to innovate. As Cigna moved into IaaS and PaaS over the last five years, capabilities increased. Reed admits, however, this structure is a big burden on his team. 

What’s Shifting and What’s Not?

Many industries, including healthcare, are shifting to the public cloud. Cigna’s main reason for making the shift was for agility. “There are things we can do much faster in the public cloud than we can do inside,” explained Reed. For example, they wanted to try to do something new in the analytics space. A project that would have taken six months only took eight weeks in the cloud. The project was a success. However, Reed explained, even if it had failed they would have only spent eight weeks and a handful of dollars. 

However, data centers are not dead. Reed said they will be around for a while for these five reasons:

1. We are still using mainframes. No one is providing an alternative in the cloud that makes sense right now.
2. Most data still sits in data centers (data gravity). As we do more in the public cloud, that will shift. 
3. We’re still using thousands of legacy apps that were developed over the last decade, and were not made to be used in the cloud. 
4. The developer community is shifting. Most companies went through a cycle of outsourcing development. Now, they are struggling to have the internal talent to handle an agile, innovative environment. 
5. We must now think about the costs. For years we’ve installed equipment or new software and never thought about turning it off at night. With cloud-based solutions, you are paying for running CPUs and spinning discs during off-hours.

Reed summed up current and near-future trends in these four statements.

• The data center still has a role, for now.
• The use of SaaS is skyrocketing in healthcare for good reason. 
• Healthcare organizations must balance risk and innovation
• Companies must think carefully about their application strategy. What are you going to do with the thousands of legacy apps still out there?

Challenges to Making the Shift

“Infrastructure exists to service applications,” explained Reed. Start your shift by thinking from an application standpoint. “Application rationalization is a big part of what needs to be done.” That can be a challenge because people are often protective of applications they’ve been using, even though they complain about their functionality. Reed encouraged listeners to start with systems of innovation, things close to the market that need to be agile. They are ideal for cloud development. By contrast,  applications of record, such as payroll or GL programs, change less frequently. Companies must take a candid look at what will be retired, what can be modified and what will be new. What can be cloud native and DevOps-based?

Governance is also a challenge, but also an opportunity for change. Cigna has defined an owner, a CoE, whose job is to be the guidepost and help everyone get where they need to be. Reed stressed the importance of understanding the landscape of governance, communicating well (especially to Shadow IT), and learning to love your audit.

Attracting and retaining talent can present another hurdle. In the late 90s and early 2000s, companies frequently outsourced IT talent. That resulted in a landscape of entry-level talent and senior IT managers. Reed explained that a career path gap was left. Now, the world is demanding development, and companies are struggling to bring that talent back in-house. The world is changing every day. Companies don’t have the luxury of sitting, planning, and outsourcing development that could take six months. “Every day, you’ve got to be making changes and innovations in the marketplace to stay ahead of it,” Reed said.  

How Cigna is Meeting Challenges

Here’s how Cigna is meeting the challenges in these three areas. 

• Talent: Cigna has developed a curriculum in partnership with AWS to help people who want to take an IT path, and get trained and certified. There is not enough talent out there. Cigna focuses on a great entry-level program to grab talent as they are graduating. 
• Legacy: Reed encourages listeners to “pick their battles.” In many cases, Cigna is going with new development because legacy apps will eventually just go away as they are replaced by new. 
• Governance: Cigna works with internal partners and has a centralized authority, a team that focuses on governance and keeps everyone on the right path. 

Reed concluded his keynote focusing on business alignment. Cigna started their transformation out of necessity. Digital transformation was necessary for them to meet the needs of patients and providers, as well as compete in the marketplace. 

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