Improving Plan Optimization: Why Making Healthcare More Efficient Starts with a "Whole-Person" Approach to Benefits Design

In today's highly saturated benefits marketplace, employers are struggling to identify the best healthcare options for their workforce. Avoiding point solution fatigue, addressing chronic health conditions like diabetes, and lowering costs are among their top concerns. Beyond that, employees are confused about how to use their benefits and find care -- often leading to care deferment, even higher costs, and worse health outcomes.  In this fireside chat with Cigna Healthcare's U.S. Employer Chief Strategy Officer Heather Dlugolenski, Heather will discuss why making healthcare more efficient requires a holistic, "whole-person" approach to benefits design that considers and connects an employee's physical, pharmaceutical, and behavioral care. She'll share examples of the unique challenges facing small, mid-size, and large U.S. employers today, discuss how they're approaching benefits design to attract and retain talent, and highlight where they have opportunities to improve benefits optimization and lower the total cost of care as they look towards the future. In her role sitting at the intersection of strategy and technology, Heather is keenly aware of the importance of innovating across affordability, access, and experience to provide the personalization and flexibility consumers need to make their best healthcare decisions. During this session, she'll share strategies designed to help support the overall health of employees, reduce the burden of high-cost conditions and their potential comorbidities, as well as advance worker well-being and productivity - all of which help ensure an employer's longevity and success.   What you'll learn How to take a "whole-person" approach to benefits design to attract and retain talent Strategies designed to help support the overall health of employees and reduce the burden of high-cost conditions and their potential comorbidities The importance of innovating across affordability, access, and experience to provide the personalization and flexibility consumers need  Unique challenges and opportunities to improve benefit design depending on employer size and segment.

Transcription:

Deanna Cuadra (00:09):

All right. Good afternoon, as you said, final stretch. But this is going to be, I think, a fun and very vital conversation today. We're going to be talking about how you can take a whole person approach to your healthcare benefits, and we'll go beyond the concept of Whole Person Health and get into the practicality of it. I'm joined here by Heather Dlugolenski, our Senior Vice President, US Employee Strategy Officer at Cigna. Heather is responsible for this strategic financial and operating performance of all things healthcare benefits from your medical, behavioral, supplemental, dental, vision, and of course pharmacy. I don't want to take too much time from our expert here today, so I'll go ahead and dive in. To start terms like holistic health and Whole Person Health have been huge buzzwords in the benefits space in the last four years. The first thing I want to ask is how do you actually define Whole Person Health?

Heather Dlugolenski (01:01):

Thanks, Deanna. It's really nice to meet you. This is my first time at this event, so I want to thank Employee Benefit News for activating this industry, and it's a really intimate, well done event. So thanks. And then thanks for you all for showing up for the last 30 ish minutes. So I'm hoping to give you some context that is instructional in nature, but to Deanna's very good point. Terms like Whole Person Health and holistic Health are very broad. They're used to describe many different circumstances. So I'm going to give you my point of view. It's an N of one, my point of view, but I'm hoping it's helpful. There are two things that stand out to me as very significantly relating to whole person health that I'll talk about. One is behavior and behavior change, and two is the fact that there are aspects of health that are not the absence of a physical symptom or the absence of a suggestive or positive or declarative test result.

(02:06):

So those are the two things. I'll talk about them for a minute. As it relates to behavior and behavior change, these obviously are lifestyles and habits and routines and goals. And yes, some of these behaviors are changes that people make when they have a physical ailment or a test result that says that there is something to pay attention to. But to me, whole person health suggests that you have whole person health when you have healthy behaviors, whether you have an illness or when you don't. And so that I think became a thing to America anyway in the seventies when we started to realize how much diet contributed to health. And from there there's been an explosion of innovation and services that help people understand obviously diet, but more than that, how to adopt and how to have consistent and ever progressing healthy behaviors. So that to me is clearly whole person health.

(03:16):

And then the second is the fact that there are other dimensions of health that aren't physical. And clearly what everyone relates to when you think of that is mind mental illness and or substance abuse. And for me, this became something that I could really understand during the opioid epidemic. It was probably just based on where I was in my career at the time. I was starting to put things together and notice what was happening and apply it to terms that I was hearing at my job. And so seeing how substance abuse and or inclinations to have dependencies on opioid became such a national event that created implications for America's whole person health. I think we all in this room can relate to how important the correlation is between healthy mind and physical mind. Like pick your favorite statistic, but we know that 40% of people that have depression are likely to have a very severe cardiovascular event and people that have longer term health conditions, a third of them are having an accompanying mental health condition.

(04:35):

There's a million statistics. This has created a bunch of explosion in a really positive way around innovation to help people with mental health needs. And maybe more importantly than that, have them in experiences that you wouldn't otherwise think they should so that they're visible and they're relatable to people when they need them. But going one step further, I actually do think it's more than mind and body. And so this is one of two times max that I will use Cigna, who's the company that I work with in this conversation, but Cigna did a study recently and they did a study that was really trying to get underneath what makes people vital. So Deanna, I don't know if you use the word vital in your setup for a reason or not, but anyways, that resonates with me for that reason because we studied it and we're basically trying to prove what makes people vital.

(05:36):

And what we found there is yes, it's physical and emotional health, but it is more than that. So it is environmental health, it's spiritual health, it's purpose, it's financial health. And maybe most importantly for employers in this room, it's how people feel about their relationship with their company and do they feel like they understand how they help the company and do they have a healthy relationship with their manager? So the reason I told you about that is I think these terms are broad. That's what they mean to me. I think they'll continue to evolve and that's good for our industry because it will push us to do better by all the dimensions of health that matter.

Deanna Cuadra (06:15):

And then taking it sort of into what it looks like in practice and as an employee and as a leader. Can you give an example or examples of benefits that you feel were designed with a whole person approach?

Heather Dlugolenski (06:28):

Yes. And I'll talk about if it's okay, benefits and experiences. And I'll try to do this in the following framework. So experiences as a healthcare consumer, a point of view as a leader in an organization that's working with a lot of people in the health and health related services industry. And then third, as a person that is trying to actually develop solutions to impact whole person health. So as a consumer, I'm pretty lucky. I really have only had very few, I would say events in my life and I'll talk about just two of 'em, having my children and losing my father and both of them had a whole person experience for me. So I'm going to describe them with my children. I had both of my kids through C-section. My first, both of them, I actually came out of physically strong, so I was very lucky.

(07:33):

But with my first, I was going through a typical narcotics slash opioid regiment of recovery and I started to, in the hospital display signals of dependency. So I remember this, I was looking at the clock on the side of the room and watching the large needle and watching it move and waiting for what my next dose was. And I was asking too many questions about when is my next dose. And so my team that was helping me in the hospital noticed that I was exhibiting behavior that wasn't typical and they changed my regimen of medication. And back to the opioid epidemic, it's like one in five people are predisposed to getting addicted to opioids if you're on them for somewhere around 10 days. So maybe I was one of those people I don't know. But my staff recognized a whole person opportunity and they intervened so that I come out on the other side with Whole Person health and not just a healthy surgery recovery, but a healthy mind.

(08:35):

So that's one. The second is a little related is when I lost my father recently and after devastating and was not really talking to anybody besides my mother and my sister, I had an OB GYN appointment relatively close to his passing, and I had lost a lot of weight. So she was responding to my physical weight loss, but asking me behavior questions when she asked me behavior questions, I adore her. And I opened up about she knew my father had passed, but I had talked about it more. We actually talked about what I should do as a result of that, and I ended up actually using our EAP, but she was responding to my physical status, leading me to behavior questions. And that gave me a better whole person health outcome as it relates to, I'm a leader in an organization and I mentioned this vitality study actually opened my eyes to my role in Whole Person Health for the people that are working with me.

(09:41):

So I'm taking it very seriously that I have a role in their health. And so I've been learning a lot about psychological safety and the work environment and everybody's got to performance manage. You have to accomplish business goals, but you can create psychological safety with transparency, communication, honesty. And so I'm practicing that because I know now that I actually have responsibility for Whole Person Health for a lot of people as it relates to that. I'm a person that's trying to develop Whole Person Health Solutions. So I feel fortunate. I work at a company that has access to a lot of data on people. We understand a lot about behavioral health, we understand a lot about medications. We understand a lot about claims and social determinants of health. That's not enough. We need to understand more about what employers have as needs. We understand more about what consumers and employees are expecting as it relates to services.

(10:41):

We take all of that and then we figure out where the places are that can impact, where the places are, where we can impact whole person Health. And then we figure out though, can we intervene in a way that it's plausible to be a part of the solution? Because not every time we can and we come up with design, but then this is really important. We are testing and learning and figuring out what works and what doesn't work in abort when it doesn't work. And the last thing I'll say on this topic is it is about that we have a role in designing solutions that we would launch and hope to have a role in an individual employees whole person health need. And we do hope that, and we do try to do that, but the two examples that I gave you about my consuming care were my physician. And so we care a lot about enabling the physician with the right amount of information and enabling the physician that would be high performing. These are the ones that are going to care about whole personnel to actually see more customers and help them be a part at the very tip of the spear in impacting whole person health. I don't know more than us, but as much as us.

Deanna Cuadra (12:02):

And we can kind of guess even from what you've described that qualities like personalization and flexibility are super key then to designing benefits that are holistic. Can you talk a little bit about what it looks like to integrate those qualities and why it's so crucial for benefit leaders to be thinking about how to make a benefit adaptable and flexible?

Heather Dlugolenski (12:24):

Yeah, sure. All right. I'm going to start. Personalization is another one of these terms that is very broad and I think means a lot of different things to a lot of different people. So I'll define how I'm going to talk about it in case that's helpful. So personalization to me means the process of customizing a solution or a service for a group of individuals or to an individual. So with that definition in mind, and if I look back on a decade, I think our industry has progressed personalization. Well, when you think about 10, 15 years ago, it was a plan design that you gave to everyone. It was a disease management program that had maybe a shallow sweep across asthma and diabetes and cardiac, but it was kind of the same thing. It was just with a little bit of different content. And the industry has definitely segmented into narrower, more precise, more personalized solutioning.

(13:41):

So for those that care a lot more about saving for retirement, we have benefit designs that support that. We have solutions that are not about having babies only. They are about people that struggle with fertility to help them have babies. We have solutions that are not the broad disease management that I talked about, but specialized in diabetes specifically. And not just having diabetes, but getting in front of diabetes with pre-diabetes programs. So that personalization is breaking the groups to be more narrow, which is really good, but now it's getting even narrower, which is also really good. So it's not just women's health fertility and babies, it's menopause. It's not oncology case management, it's breast cancer case management and colorectal care case management. And it's not just behavioral health, but it's autism, neurodivergent young people with mental health. That is also excellent because the groups are getting smaller and smaller.

(15:02):

Some of these companies may be getting to the individual person that has that small niche need but has a different socioeconomic situation or a different local situation. I'd say most of them are probably not that personalized, but let's pretend they're going to be because advanced technology affords us the potential to think that that's possible. So that's great. What is really important for our industry collectively is to figure out how to take all the personalized solutions and then create a personalized solution to figuring out how to deploy them to the right people that have that need in the time that they need it in the channel that is most appropriate for them to actually consume it. And that does keep me up a little bit at night because if you look at, and you guys have done business with a lot of early stage companies when they don't work, oftentimes it's because they can't get to the people.

(16:20):

And so they don't have the engagement and then they can't prove the ROI. And so I just think the days of a blurb in the benefits newsletter or an email to a hundred people that we think are in the category or a website that may have all the different links in it, it's just not going to be enough. So that to me is really important. When I say these words, like people say, yeah, navigation, right? And I think that too, that it is. I'm defining navigation. I don't know that a solution can do what I'm describing on its own. I think that navigation has to be core in the fabric of all the larger entities that are a part of this system and the smaller ones too. But I just think that it won't evolve unless the larger ones figure this out. So that's where I think about personalization, where it's been where it needs to go. And I guess the good news is I think what I'm describing everybody knows at this point, and I do think that technology you all as influencers in where the industry goes can move this to the next level because I fear innovation will get stunted if it doesn't.

Deanna Cuadra (17:52):

And of course then the next question, the big question I think especially for people teams in the last few years is can we afford better benefits? Is it possible to up the quality of our benefits without or while still saving money somehow?

Heather Dlugolenski (18:10):

Okay, so I don't know if this is good news or bad news, but I think it's important to start with this. There is still a lot of waste in the system. So that's bad because like why does that have to be the case? It is an opportunity. So for those of you that are struggling with can I create more outcomes, whether that's affordability or quality or insert, there is waste for us to collectively get after. And again, insert your favorite statistic, but the one that I think is like 25% or so of care is either avoided or redundant or could be done in a different setting or with a different physician. Now the way that I think about answering this question though is hard because there is no silver bullet because every employer has got a different set of objectives. The same way that personalization goes to the employee.

(19:27):

You got to apply personalization to the employer. You all have different workforces, you all have different economic statuses of your companies, you have different budgets. Your employees are advocating for different things. You're in different industries competing for talent. So there really to me is not a silver bullet answer, but if I just try to draw a line in the sand on what would be the fastest way to getting at this inefficient care that you do could control, it really is marrying up to me anyway, marrying up with an administrator, small, big whatever, that you trust in the way that they are measuring what high performance is and you work with that carrier to create a strategy. Could be immediate, could be over time where you are really incenting your employees to go to the high performing care that you have designed around. That does create a lot of affordability quickly if you were able to implement it in a way that you're controlling where employees go, and you could do it over time through a benefit design strategy, but there is a lot to unlock out of that approach.

(21:00):

But I know because believe me, I wish that could happen overnight with most employers. I know it can't because employees want choice. And it's hard to navigate a strategy like that knowing that that's true. So I do tend to think though that more aggressive moves in this direction are going to be more on our minds. And the reason I'm saying that is just as new technology hits the marketplace, it's really good for society. And whether it's weight loss drugs for GLP, whether it's for fertility to help people have babies, whether it's all of these new cancer tests that potentially come and they help people understand whether cancer is somewhere in the future, but they don't get rid of mammogram and colonoscopy, new costs are coming in and I think we are going to have to figure out a way to balance how we think about costs, but with outcomes in the future.

(22:03):

So I think this is somewhere in our future as more kind of a thing. Having said that, I do think as a carrier what our job needs to be is to not have two different flavors of a way that we can administer that back to you all being very individual employers, I think we need to have baseline networks. We need to have trusted criteria, but we need to be able to really nimbly flex and say, okay, great. Want to start with this network, add these three in. Fantastic. We'll do that. You want to start with this one? Take those four out. Great. We can do that. Whether it's because geographically there's a brand that matters a lot to you, whether it's because your CEO is on the board of somewhere else, whatever. Well, we have to be more nimble to figure out how to move in the continuum with you in a way that's more flexible.

(22:57):

We do have a program that I feel like brings this to life. It's called pathwell Specialty. So this second time I'll talk about Cigna, but it's a good analog. It's a program that is designed to create affordability and outcomes around folks that have specialty conditions and therefore require an infused medication. So we have a high performing infusion center network. We work with them one-on-one with a high intense case management program. So clinicians, we drive down costs through the high performing network and then we negotiate one-off deals. If in fact the system that isn't in the network is willing to do that. But then we wrap it with whole person health. So caregiving services because we know the family needs it, nutritional services because we know diet is really important during this time. And so it's just something that I think gives you a little bit of an example about what we are doing now. Easy to do because it's a small number of people, but over the time I think is got to be a way that affordability is accomplished, but at the same time accomplishing quality outcomes.

Deanna Cuadra (24:12):

And I think we have time for one more question and I'll ask for the people teams out there and for the benefit leaders out there, what would you say are the first few steps that people teams need to take in order to sort of start that journey of improving their offerings?

Heather Dlugolenski (24:33):

Okay, I'm also going to say knowing this is my point of view, I don't have your jobs. Although I do think sometimes when I'm talk to employers, I actually think our jobs are somewhat similar and I will talk about that a little bit here. So just for what it's worth, these are things that I think are important. So one is starting with data. You guys have a lot of data about your workforce, their demographics, their claims experience, you survey them. So keep doing all that, but benchmark yourselves in the industry. So who are your competitors? What's their premium strategy, what's their benefit strategy? And from that data aggregation, which should include things that you own, but should definitely include things that you get from an unbiased consultant that's going to tell you about the world in a way that you can't get create goals. But over time, and the reason I'm saying that is because this is very complicated and on any given year, I think you probably, because I do this, you probably have to have a primary goal, right?

(25:42):

I'm going after this this year. It doesn't mean that I don't care about this, but it means I'm going to get after this in the second year or the third year. And that might mean that I put a little capacity towards this in my short term, but I'm going to put the majority in my capacity towards this because it's the most important thing. So like multi-year roadmap and goals that are associated with those years, that's going to allow you to make decisions about your strategic partnerships better. I'll come back to that in a minute. Another thing that I have seen work for employers, and I do this a lot at a big company that I work at too, is operating committees. So folks in the business, maybe in finance surround the benefits organization are part of building that strategy to goals are part of the decisioning on what you're going to do. They help with the change management associated with actually getting there. When you get there, they help with the decisions when you're making one and the CFO comes in sideways. So that tends to be a good operating practice. I think for anyone that's trying to make these kinds of moves in a significant way.

(27:07):

I think getting to know the people at the companies that you're signing up with that are a little behind the curtain. So the account teams, yes, but there are people like me that are running strategy, that are designing products, that are managing the contracting and or the supply chain that are planning for their year 1, 2, 3, and the goals that they are trying to accomplish over that time period. So you should know those people and you should know because you're making a decision about the short term. And that's the majority of why you're stepping into a relationship typically. And I know it's hard to find a carrier or a company that's got everything hung up together. So if you have exposure to those people, you at least will get a sense for, am I just buying what I need in the short term or am I actually buying into what these guys are seeing and trying to do over multiple years On that front, I also think talent is an interesting opportunity for employers. As I get to know more about your days and what you do. You are mini strategy and product teams, so you're doing that for your own health plans and the product skillset is different. And as you're thinking about talent acquisition into benefits, if you don't already hire product people, I think it might be cool to hire product people because they do this and they do idea to oversight, to execution. And it seems like you guys are doing that all day.

(28:56):

I would ask a question like when you're about to close a relationship or a bid or whatever, what's my role in the success of this initiative? If you don't have one, I would be speculative because at this point in innovation, I think it takes a triangulation of a company, the employer and the provider to accomplish most things. And then lastly, and this is maybe my most important point,

(29:28):

I've seen companies fail because they get caught up in what they committed to with the employer and especially earlier stage. So hold on, I said I was going to build this. And as they start building it, they find out that's not the right design and then they can't figure out how to walk back from that and change the design because they made a commitment to the employer and so then they can't pull it potentially all the way through. So my last point is figure out whatever way that is comfortable for you to embody the mindset of test and learn and allow some liberty for some of the companies that you're working with to change the approach if they give you a real reason that it needs to be done. Because I just have seen that be a point of challenge. So I said a lot of things because I actually thought that was the best question and obviously had a lot of thoughts, but that last one I think is the one that I actually would ask you to think the most about.

Deanna Cuadra (30:42):

Alright, I think that wraps up our fireside chat. Thank you, Heather. And yeah, thank you everyone.

Heather Dlugolenski (30:47):

Thank you, Deanna. Thank you everybody.