Inside Cigna subsidiary Evernorth’s plans to mine data to identify at-risk members

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

Behavioral health network Evernorth has doubled in the past five years, the company disclosed last week during 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 currently includes more than 250,000 providers.

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

In 2020, Evernorth signed an agreement with Quit Genius, a digital health clinic that treats addiction, to make the product available to its members. Last year, Evernorth partnered with Alma, a business services platform for independent mental health practitioners.

This interview has been edited for style, clarity and length..

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

Evernorth is the healthcare services arm of Cigna. We are able to bring together our data and analytics capabilities, deep clinical expertise in medical and behavioral health (in which I am most involved) and pharmacy areas in a coordinated manner.

What specific health services are we talking about?

We have a vast capacity for innovative services across Evernorth. This includes things like pharmacy services – the ExpressScripts brand and some of the other pharmacy management companies that exist through their specialty pharmacy and so on.

We have the ability to manage behavioral health from a benefit perspective and also to provide care.

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

Part of Evernorth really focuses on analytics and data capabilities. Being born out of Cigna and having such awesome capabilities like ExpressScripts and behavioral health, we have a lot of data. [We] have the ability to coordinate this, integrate it holistically, create algorithms and perform the analytics that allow us to meet diverse customer needs.

Who are Evernorth’s customers?

Our clients can include a wide range of employer clients, other health care plans, government – the full range of entities that provide care and care services.

It’s interesting to hear Evernorth talk about providing services to other health plans. It looks like these kinds of services would eventually help compete with Cigna. Am I thinking about it the right way?

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

This could be in the case of an MDLive type solution to help them provide additional virtual care capabilities that they do not have in their networks.

From a behavioral health perspective, sometimes it’s about tapping into our strong autism-focused networks, managers, and clinicians.

The other part of what we do by bringing Evernorth together, we create unique new solutions – especially in my world of behavioral health and pharmacy – in a way that other health plans don’t have the ability [to do].

What areas of behavioral health are Evernorth working in the most?

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

Due to the pandemic, there has been a 25% increase in the number of people trying to seek behavioral health support. But there is a shortage of suppliers. There is stigma. People don’t understand the behavioral health ecosystem.

We have the ability to leverage our data and analytics to identify people earlier and engage them in the right direction to meet their needs and provide better access to care, to simplify the behavioral health journey.

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

You mentioned the shortage of suppliers. How does Evernorth handle something as big and intractable as this?

Across Evernorth today, we have a network that includes more than 250,000 behavioral health providers who practice virtually and in offices across the United States. This is not enough to meet everyone’s needs. So [the question] becomes how to expand this network in new and innovative ways?

One of the things we’ve done is look at how [to] start bringing in coaches, peer helpers, and other levels of professionals who can help meet the needs of people with mild, sub-therapeutic issues like stress so that those people don’t book therapy appointments than anyone else who needs this therapist [might need].

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

We quickly moved to 60% of outpatient behavioral health visits being conducted virtually. Today… we still see 50% to 60% of our outpatient visits taking place virtually.

The other way is to find other innovative partners who are beginning to develop new and innovative ways of delivering care. Again, the pandemic really accelerated that. We now have partners providing care for substance use disorders virtually and are able to do so at scale. We have innovative programs treating eating disorders virtually and enabling people to seek care at home in new and innovative ways.

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

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

It’s about looking at our medical data, our behavioral data, and our pharmaceutical data and putting it into models that help us identify people with behavioral health needs and get them to the right ones faster. care.

We now have a predictive model that identifies the children most likely to be diagnosed with autism within the next six months. They are not yet diagnosed. But we can look at their pediatrician’s claims and other things that are going on in their life and say, “Hey, we see this pattern and know that when this happens, this child is at high risk of being diagnosed with the disease. ‘autism.”

In doing so, we can engage the pediatrician [and the] parents and bring this child to the right place to see if he has this diagnosis and if so, start him on a care app to treat autism sooner.

Another example is around… [identifying] people at high risk of overdose within the next 30 days. We can call on our case managers and clinicians to reach out to…the person for support [network], [find out what’s going on]and make sure they get the right kind of care – whether it’s care for substance use disorders, medical care for chronic pain, etc.