When it comes to providing health benefits for employees, some employer groups require a high level of customization and flexibility. To meet their needs, they may opt to work with third-party administrators (TPAs) or health plans.
Enter Evernorth Payer Solutions, which provides a breadth of complementary solutions, including access to Cigna Healthcare medical networks and Evernorth behavioral networks. Some employer groups may also choose to access the Cigna Dental preferred provider organization (PPO) network, Cigna LifeSOURCE Transplant Network, pharmacy benefit management, case management, out-of-network savings programs, and other affordability and clinical solutions, such as Embarc Benefit Protection.
To better understand the role that this team plays within our organization, we sat down with Diane Zalewski, president of Evernorth Payer Solutions, who walked us through the work her team does, the value proposition for TPAs and health plans, and some of the major milestones this segment of the business recently achieved.
Tell me about yourself and your role at Evernorth.
I live in Connecticut and have two adult sons. I love dogs and everything about the outdoors – hiking, biking, and gardening. I think what’s unique about me and my career is that my first job out of college was in health care underwriting with Cigna, and I’ve been at Cigna ever since. I’ve worked within many different departments, including the U.S. Employer business and product marketing, and today I lead the Evernorth Payer Solutions team. The knowledge and insights that growing up at Cigna has given me are indispensable to the work I do every day. My role encompasses overall strategy, distribution, and operations for Payer Solutions.
What does the Evernorth Payer Solutions team do?
The Evernorth Payer Solutions team develops and nurtures relationships with TPAs and health plans to help them serve their clients (employer groups and brokers for TPAs) and members (for health plans). It’s a B2B2B2C relationship. We provide access to our medical networks and other solutions, but TPAs and health plans are the ones that bring these solutions and networks to brokers, employer groups, and members.
We think of ourselves as training the trainers – in that we must bring our value proposition into an organization that is also distributing other products and services, other vendors, and networks. We pride ourselves in the work we do to collaborate with and educate our clients so they can bring our value story forward to the employer groups and brokers that are the ultimate purchasers.
What’s the value proposition for health plans and TPAs?
The Payer Solutions team is a collaborative, consultative, and trusted partner. Our goal is to bring market-leading products and solutions that enhance the value TPAs and health plans bring to their clients and customers.
What sets this team apart is the depth and breadth of expertise in this space. Our keen focus on education, focused listening, and partnership is a proven approach that has fueled growth in this segment of our business and enabled us to identify strategic opportunities to continue to drive growth for the long term.
The products and services we bring to market are a core component of our value proposition – the Cigna Healthcare name delivers national recognition to our TPA clients and national presence for our health plan clients. We also leverage the power and innovation of Evernorth to provide value and affordability through industry-leading therapies and medications. Notable Evernorth solutions are embedded within the Cigna Healthcare PPO network offering, including Accredo specialty pharmacy, behavioral health, medical benefits management programs and buy-up options from EviCore, and more.
Our well-known network offers a broad choice of over 1.5 million doctors and hospitals, including an extensive behavioral network, coupled with competitive discounts. Our clinical programs address high-cost conditions such as oncology, and products such as Embarc Benefit Protection provide affordability, predictability, and access to lifesaving gene therapies. Additionally, our specialized pharmacy benefit expertise through Cigna Pharmacy Management includes innovative plan and formulary options like the Patient Assurance Program. Our pharmacy operational model is differentiated by our high level of service, helping us to meet the unique needs of TPAs. These are just some examples of the value we bring to our clients and members.
What have been some of the greatest achievements for Evernorth Payer Solutions in the last year?
In 2023, Payer Solutions saw a 36% year-over-year growth. Membership growth was supported by two large health plan implementations with more than 1.4 million new members. Stability in our medical network was also a factor.
Other key accomplishments include:
- Led an automated clearinghouse eligibility response to providers that helped to improve customer and provider satisfaction.
- Brought claim editing in-house through a Cigna Healthcare proprietary solution, which has driven an 11% increase in gross earnings.
- Rebranded to Evernorth Payer Solutions to better enable clients to leverage the value of Evernorth.
- Improved infrastructure to enable clients to add Evernorth offerings more simply and quickly.
- Supported the expansion of Embarc Benefit Protection and the inclusion of new therapies in the program.
- Partnered to deliver Evernorth Workplace Care.
What’s next for Evernorth Payer Solutions?
We are creating a medical network that will bring even more flexibility and modularity – so that we can utilize it as an enterprise asset for all of Evernorth Health Services. Over the next 12 to 18 months, our focus will be on modularity, creating avenues to new solutions, and identifying new revenue streams.