Healthcare: Cigna
Digital Transformation
Case Study

Prepared by Robin M. Gregory, CEO
mobileLACE, LLC

The content herein is based on my own personal experience, observation and collation of direct engagement interviews – with participants involved in creating policy, rules, process and technical functionality that would enable the operational shift for healthcare and its ancillary services away from volume and over to value.


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This case study was executed over three years – in 2013 I was a consultant embedded in a Big 5 consulting team – the other was as a consultant turned FTE working inside the L.A.C.E in 2015-2016.  The proper ingestion and streamline of the data input process with accurate and logical usage of the shared data – to help create sustainable healthcare value, occurred during my first point of entree into this enterprise – wide healthcare digitization transformation. The effort that followed was big – it encompassed infrastructure, process, tools, policy and mindset shift needed to support the shifting industry model from volume-based to value-focused patient care with an eye on fluidity, portability and transparency, in order to yield whole patient health care into higher quality health results for the patient. 

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My business and technology transformation experiences really started in 1994 – you can listen to earlier case studies for Telecommunication: MCI WORLDCOM, and International Real Estate for Eco-Tourism on the Placencia Peninsula of Belize, CA – on our  “Digital Alchemists” podcast. As an Enterprise Business Analyst, Enterprise Transformation Coach and now CEO, I have strategized solutions from the 90’s until 2019 – when I took my collective collated experiences over 25+ years and strategized the mobileLACE model; then with the mobileLACE team it was developed in 2020-2021.

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From 2013 thru 2016 CIGNA was facing huge constraints around: 



The Environment:
Cigna was and still is a trendsetting global healthcare company. When I arrived, they were evaluating what they had to shift in both business processes and technology  to move to digital and to meet the technological and social change required to support major industry reform going on in the overall healthcare space. Factoring in the looming variable – what impact would the impending government entry into their space have on BAU, was another layer of change – entirely.
Data accuracy is paramount to understanding service, performance, price and or the cost of doing business and building and or selling product and services; it is especially so for our high-cost, clinically driven,  health care system – provided to patients by HCPs but systemically paid for by insurance companies who rely on legal mandates and corporate benefit packages to create revenue from healthcare coverage.  
The medical framework changes -challenging clinical and administrative systems and health professionals due to the sudden focus on health reform, included:  ongoing policy driving SAP – for the technological provision of healthcare records – impacting sharing, storing and reporting healthcare data.

The Mission:
Healthcare providers and their clinical partners – seeking ways to create collaborative transparency to meet the new model reform and compliance impacts – for now smaller issues, like:  license renewals, HCP’s moving practice affiliations and therefore networks, and state to state geo-edge regulations requiring different insurance regulations (the short list) drove the data strategy.
Larger shifts to enable changing the model for delivery of care from a previous focus on volume over to value – as both an economic and service related future model, was all encompassing – no matter the individual corporate mission.

This mandated shift ended up being the underlying cause for social accountability and changes in mindset – around every aspect in the delivery of care – truly across the board. The pivot to continuum based, holistic, collaborative processes needed to lead to achieving higher quality metrics for U.S. health – this industry vision was the root that all corporate missions needed for any growth. 

This shift would only happen when service, quality and price changed – a big disruption for a critical, ongoing industry. These transformative changes required huge technological shifts and immediate digitization of many things – simultaneously, to get to the legally mandated – sometimes life or death driven, results.

The Problem…

Because the healthcare problem was a country issue – with the United States spending more dollars per capita than other similarly developed nations, yet failing with country health metrics for some time now; many agreed that the passing of policy to drive change had to happen relatively quick.

During the presidential debate of 2008, discussions that would drive the fate of the US healthcare system began, and by 2010 – the Affordable Health Care Act was passed under President Obama.  

The commitment to the tri-metric, re-calibration – around healthcare systems to meet the emerging need for quality delivery of care, demanded a new Value Economic & Value Care framework be adopted. 

Cigna began to respond and change systems immediately to move from volume to value; starting with their Intake Workflow and moving into many other processes, systems and products that were limiting due to the old model philosophy.
Shifting cultural intelligence in order to institute the social awareness needed for the mandated change – as with many other company transformations going on today to catch-up to digitization, proved to be most challenging – internally.  Yet, Cigna strategically determined that the best impetus for their external solution was working to assist HCP’s in the Cigna networks.  So they did!

I believe their effort created a superior and ethically intelligent model that any healthcare insurance company could follow.  Leadership made the decision to begin rewarding healthcare professionals – whose health metrics rose due to using new managed care methods resulting in higher levels of wellness – less clinical testing, and more collaboration.  However, like other large companies in different spaces – also evolving into digital – shifting the architecture already in place requires herculean efforts.

However …

Data inflow, retention, storage and reporting integrity –  a challenge during technological change, was adjusting first and the workflow change to accomodate the system with clean, accurate and safe data was underway.
The V to V model shift was more integral and interdependent; it needed to be mapped out horizontally – across orgs – quickly, but it ended up difficult to deliver effectively and with speed  due to organizational processes in place (that often plague many transforming companies) such as: financial budgeting, resource sharing rules, platform architecture and political shadow cultures. All of these – put in place over the ten years since a major merger created Cigna ended up to young to be wrong, but to brittle to withstand the new constant – dynamic change!   

Again, like all other businesses facing digitization Cigna wanted to change, but found the holistic approach foreign and antithetical to its in place organizational structure.   The differentiator for Cigna – was relative to people in the healthcare business; because these processes dealt with life changing access or denial to procedures that human beings needed – due to chronically impairing or acutely malignant illnesses that presented life and or death situations the people at Cigna – the company with heart – the people who care, catapulted into persistent action.  

The Tri Fecta Transformation – Internal, External & Industry Disruption 

Workflow Software automation assisted with what used to be a cumbersome, error laden, manual process: eliminating duplicate entrees, Junk emails, misdirects; updating proved difficult but the strategy was effective.  Creating an agile program – grew to be huge due to the all-encompassing impacts brought on by the industry shift. Co-ordinating the mandated execution (bi-modally, so that shifting from volume to value would be available both internally and externally in a synchronous manner for: HCPs’, clinical partners, Cigna plan members, administrators of healthcare and Cigna employees) from the insurance and the patient care side – slowly revealed that it would take years, and lots of sweat equity.   

Solution Benefits:

Large companies – with no effective leader to evangelize the digital cultural shift – in this case the use of the hero-mental model, out of processes needed to move agility across the enterprise, always experience slow and painful change. Without the leader who started the agile journey – and his high level recognition and knowledge around decisions for transformational success, an incongruent ride occurred too early on to smooth the bigger waves that would come as time passed and processes changed. The many external market challenges were keeping Cigna leaders in a constant state of pivot and this demanded a high use of consultants. By virtue of that model this sends an enterprise into a revolving door flow, with a flavor of the month pattern that does and undoes more than not.

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Intake Workflow Data Integrity:

Intake of data in healthcare has many integration points for the insurer. Healthcare professionals, clinical support from blood-work to major surgical procedures, the equipment that goes along with that care, and the legal stats from providers of the care, as well as the members who use the care products with the affiliated HCP’s. Data is key to quality health care.

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Streamline the data input, scrub the data – keep the data clean, and then report it in the correct place; creating ease of use for both insurance members and healthcare providers. Secondarily, use data gathered – in other ways, to further assist with holistic healthcare reform.

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Medical Framework Changing Required Social Shift:

The foundation of value economics and value based models, over volume based approaches required changing one’s social view from the initial point of service for insurance members within the HCP’s networks and the HCP’s themselves. The tri – metric re-calibration around healthcare systems for the new emerging quality around delivery of care required collaborative systems, processes and the application of cultural intelligence into the workflow. It seemed likely – that this would take some time to institute – perhaps, several decades. Yet, the mandate for this shift was to start – now.

3rd Party Data Context:


Re-access what was deemed “necessary for change” according to reform. Organize it – adding understanding around architectural obsolescence and dependencies between orgs. A large integrative effort was needed – to create real systemic changes that could meet the V to V policy mandate. Upon my arrival changes were already underway – the goal was to get it done in the least amount of time – with the highest quality. However, architectural change in a hybrid bi-modal process without a leader orchestrating strategy was rough.

Constraint 1:
Intake Workflow Data Integrity

Multiple types of data input, old rules around data process and navigation in the system.

Transformation Solution:
Institute an automated workflow software that ingested multiple types of data – input by HCP’s, and presented on public facing platforms used by Cigna members.

The goal for achieving data integrity -included applied rules and routing to support licensing, networks and insurance regulations state to state. As well, technological functionality to deal with duplicate entry, misdirects and audits for transactional and outcome based events was developed. Dashboard viewing would allow metrics for a transparent view into performance.

Constraint 2:
Volume to Value Model Shift

Cigna efforts – I believe were and still are a model for healthcare insurance companies to follow: rewarding healthcare professionals whose health metric performance rose due to better managed care with results: for higher levels of wellness; less clinical testing and more collaboration. However, like other large companies also evolving – shifting the architecture already in place required a herculean effort and enabling cultural intelligence to institute social awareness internally – was the political stalemate that often plagues less mission critical companies due to the organizational structures already in place.

Transformation Journey:

The contextual issues embedded within the model shift from volumn based service to value based care were enormous. The greatest was related to accountability around service excellence: from following a continuum for quality based outcomes and engaging in good interface between disciplines: providers, service models, ancillary service partners, communities and individuals family and friends in a way that made care sustainable and relevent.

Constraint 3:
Government Entry Into Healthcare Space


Health insurance premiums rose by nearly 9% for individual and family coverage in the decade before Obamacare. Since 2010 increases continue close to 50% the previous rate of increase 4.0% for individual coverage to 4.6% for family coverage.

Impacts of Government In The Health Insurance Space Known Constraints For Government in Healthcare SpaceMML Solution Research 
More people have healthcare than ever before; in the case of catastrophic events or illnesses that often bankrupt individuals, they have a means to get well with being financially destroyed.   

People are forced to buy insurance that is wrong for their circumstances. Deductibles are too high for the US health wellness metric to go up – when individuals and families cannot get care for things that help them sustain being well.Abolition of the individual mandate yet retention of the tax credit for healthcare should help – if the row below is allowable.
5 or so million individuals have gotten cancel notices for their entire insurance plans – forcing them to switch to a new higher priced plan. People are being forced out of plans they need to keep because they cost less than the current day prices. 
Insurance should be guaranteed renewable with adjustments in price – justified by health data.  New finance rules for insurers might allow creation of new reinsurance – supported by actuarial probability forecasts that could potentially open up the insurance market to newcomers.  
Wages are not keeping up with the increases of – even government healthcare insurance and tax credits take away returns that may have contributed to mental wellness health in the form of vacations or things families needed but could not regularly afford. Wages have been stagnate for a long time and during Covid for some completely depleted – yet, deductibles are allowed to rise.  There should be some correlation between price/deductibles and the health of a nation its GDP or economically and criminally sustainable economy.
Allow the government to have a fixed commitment to insuring low-income but allow insurance members the freedom and education to see what their money can buy in the open market – like car insurance does or the transport and hospitality industries.   This allows healthy competition to come into this space.

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