Name: Scott Evelyn
Job: President and General Manager of Cigna’s tri-state market, including New Jersey, New York and the southwestern corner of Connecticut. He started in the job on September 1, 2013. He spends half of his time in Cigna’s Jersey City office.
Age: 50, an age that Evelyn said is significant for men, since they should consider getting colonoscopies to screen for cancer. He said Cigna has tools to help customers navigate such decisions.
What he does: Evelyn is charged with increasing Cigna’s sales in the state and retaining customers.
What he brings to New Jersey: A fresh set of well-traveled eyes, including more than 20 years of benefits management experience. Evelyn, who is originally from Florida, has lived in San Diego, Milwaukee and Fort Wayne, Indiana, as well as Long Island.
Cigna’s niche: The Connecticut-based company mostly serves employers with at least 50 employees, rather than the individual or small business markets that are receiving most of the attention on exchanges these days. While it does provide full health insurance services in which it pays a company’s claims, 83 percent of its business is acting as an administrator for self-funded employers that pay their own claims, Evelyn noted.
Thoughts on the Affordable Care Act: Evelyn said the law has increased the uncertainty that employers have about the future of insurance. Cigna is “helping guide them through the new opportunities, the new plan designs,” that result from the federal law. The law requires health plans to offer some additional benefits, including the elimination of limits on the amount of benefits that insurers pay. It also adds reporting requirements for businesses, including a mandate that employers with at least 50 workers provide insurance to all full-time workers or pay a penalty, starting in 2015, if the employers offer insurance to any employee.
Cigna and ACOs: Evelyn is enthusiastic about accountable care organizations, which encourage coordination of patient care while motivating providers to reduce costs and improve accountability by offering financial incentives. Nationwide, Cigna has formed 75 ACOs, including four partnerships in New Jersey: with Morristown-based Atlantic Health System, Hunterdon Healthcare, New Brunswick-based Partners in Care and Summit Medical Group.
Cigna has the most ACOs of any single insurer in the country and is pushing for more, Evelyn said, adding that he plans to have the company work more with hospitals and physicians in the state to increase accountability.
What strikes him about New Jersey: Evelyn started his work in the region in September after having worked for Cigna in South Florida. He said New Jersey is distinct from other markets in its reliance on large hospital systems, as well as high utilization of healthcare providers who aren’t in insurance networks, even when an insurer offers a large network. Evelyn noted that some New Jersey healthcare providers choose to operate outside of any insurance network. Since business employ workers from geographic areas that span different hospital systems, Evelyn said it’s imperative that their networks include a broad range of providers.
Evelyn added that this adds up to a challenge for insurers, with substantial fees paid to healthcare providers that are larger “than what I would call reasonable and customary,” Evelyn said. He pointed to out-of-network providers seeking fees as high as $20,000 for services that would cost $1,000 within the network.
Wait-and-see approach on the marketplace: Cigna is participating in the ACA health insurance marketplaces or exchanges for individual customer in five states, but chose not to participate in New Jersey. “We’re in the assessment period at this point,” Evelyn said.
New Jersey’s dynamics present a challenge for small-group plans for small employers, including plans to be sold through Small Business Health Options Program, or SHOP, Evelyn said. A primary way to make plans attractive to small groups is to make them more affordable by offering a narrower network of providers. But this may not work in New Jersey, where employers want networks to serve employees who are spread across a wide geographic area served by many providers.
What he sees as his employer’s strengths: Evelyn is proud of what he described as several Cigna “firsts” – launching the first 24-7 insurance customer service help line, offering web tools to compare doctors’ quality, and developing a model that predicts – with 83 percent accuracy -- which patients will result in higher claims over the next three years. This last tool allows the company to offer targeted “coaching,” in which a trained staff member works with patients to prevent chronic problems.
“Members don’t want to have a dialog with 15 different people -- they want to have a dialogue with one coach,” Evelyn said.
Making information work for consumers: In addition to quality information, Cigna also provides cost information on providers. Evelyn noted that this is increasingly important as business and individual customers increasingly choose plans with high deductibles or coinsurance (in which a patient pays a percentage of costs).
“Employers and even individuals are looking to control cost – to have a more affordable cost,” Evelyn said, adding that this is leading to more engaged customers. As Cigna focuses more on providing customers with information as well as tools and incentives for them to take charge of their own health, “we’ve really moved from an insurance company to a health services company,” he said.
The metrics used to rate provider quality have grabbed the attention of doctors, Evelyn said. “We’re actually sitting down with the providers to say, ‘This is why you’re an outlier,” he said.