Cigna’s predictive, high-cost claimants model is saving the company an average of $2,000 per participating member each year, incoming CEO Brian Evanko said during an April 30 earnings call.
Cigna’s insurance business has been leaning into AI-enabled risk prediction models to identify complex patients sooner. Once identified, Cigna can connect those members with clinical resources. The model’s savings correlate to members avoiding unnecessary provider visits, including trips to the emergency room.
Mr. Evanko said this capability can benefit the stop-loss business, where understanding the risk of high-cost claims is paramount.
Mr. Evanko also said, compared to two years ago, inbound calls dropped 20% and 25% for digitally eligible customers in the company’s U.S. employer business and pharmacy benefit services members, respectively. He attributed the dips to Cigna’s AI tools in contact centers and improved digital experience.
“Ultimately, these capabilities allow us to go beyond administrative enhancements and deliver better health outcomes,” he said.
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