Tuesday, March 10, 2009

Memo to CEO of Cigna Healthcare

Over the course of the MS-MBA we have discussed many of the issues involved in taking a product company to a service based strategy. In my view much of this entails thinking about what information you have and understanding its value to your customers. For a traditional product company it could be the design or the ability to service your product.
Cigna Healthcare is already considered a service based company. At their core they process medical claims, however there are many opportunities for them to leverage their IT infrastructure in new ways in which to leverage the contextual knowledge abilities of a national medical insurance carrier.
The basis of my recommendation is for them to open up their claims rules engine to the provider customer. Making the codified knowledge within the engine open removes many administrative layers that cause frustration and cost to both parties. Allowing access gives providers the opportunity to streamline the billing aspects of there business and improves revenue cycle management. Cigna can monitor, now in real time, provider billing and, tangentially, treatment. This gives the company an advantage when creating plans tailored for the businesses that carry the employee's/patient's coverage.
The second advantage is with the right infrastructure adjustments to make the engine a platform allowing for providers to create their own applications. With the move towards evidence based medicine, and payment based on physicians following accepted guidelines, customer apps can utilize the claims rules to ensure their internal processes adhere to said guidelines.
There is significant value to be obtained by providing the base rules to the customer and using the new information flows to improve medical care, insurance products, and consulting capabilities to Cigna clients.

3 comments:

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  2. We will discuss more about the issues that you raise for Cigna when we discuss the healthcare sector. In the meanwhile, if you have not seen this, it is worth taking a look at:

    http://www.thehealthcareblog.com/
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