Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics
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Title : Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics
link : Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics
by BRIAN KLEPPER
America’s health plans are floundering. If their chore has been to provide the nation’s mainstream families amongst access to affordable tending (let’s leave of absence lineament out of it for the moment), they have got failed miserably, though they were rattling profitable along the way, at to the lowest degree until Q1 2008. In 2008, the Milliman Medical Index – an approximate of the total cost for wellness coverage premium as well as out-of-pocket costs for a position unit of measurement of 4 – was $15,609. Now it is almost sure higher upwards $17,000, to a greater extent than than the total income of to a greater extent than than one-third of American households.
To many wellness programme execs, these are precisely marketplace dynamics that must hold upwards accommodated through novel production as well as service designs. I precisely attended a wellness programme conference where the overarching themes were the transition away from grouping to private coverage, as well as the exercise of incentives as well as touching points similar texting, email, as well as ergonomic Web interfaces to cultivate fellow member competency, loyalty as well as retention.
There are of import steps forwards but, to me, the give-and-take tiptoed about the to a greater extent than glaring job – costs this high have got exhausted many purchasers’ powerfulness to pay, as well as are chop-chop shrinking wellness plans’ commercial marketplace as well as profitability.
Several wellness programme execs at the conference pointed to the tending delivery as well as provide sectors as the drivers of cost, but that is, at to the lowest degree inwards part, also an evasion. As payers, wellness plans tin pattern incentives for to a greater extent than efficient tending delivery. They tin exert meaning pressure level on cost growth through many uncomplicated but demonstrably effective mechanisms:empowering primary care, leveraging marketplace forces past times making cost as well as functioning transparent throughout the wellness tending continuum, paying for results rather than for procedures.
But the harsh truth is that for nearly 10 years wellness plans, similar all major wellness tending sectors, have got focused on anything but cost management for a uncomplicated reason: it has been inwards their short-term fiscal interests for wellness tending to cost more. (Fully insured plans earn a per centum of total revenues. The large carriers who administer self-funded or ASO (Administrative Services Only) plans have got raised administrative fees as claims costs have got risen.) The job is that the long-term consequences of that strategy have got arrived.
It has been nearly a decade since, inwards Nov 1999, UnitedHealth Group announced that they were curtailing most utilization management activities. Their announcements said that the complexities of pre-certification had truly increased overall costs. And, of course, the physical care for was typically cumbersome as well as ofttimes idiotic, infuriating doctors as well as hospitals. In a sense, this instant signaled the transition out of the commencement major stage of managed care, at to the lowest degree as hopefuls similar me see of it, as well as into a menses of relative dormancy.
Like other wellness plans, United did a piteous chore conveying to employers as well as patients wellness care’s enormous waste product as well as fiscal conflict, or the seriousness of the approaches necessary to plow those problems around. The physicians’ rebuttal – that accountants as well as clerks, rather than doctors, were making wellness tending decisions – was good received inwards the marketplace. Ultimately, nearly all wellness plans followed suit. The Sun assault that era of aggressive medical management.
What remained unsaid, though, was that fewer controls over care, combined amongst a reimbursement scheme that rewarded to a greater extent than procedures, would accelerate overall cost growth, as well as that the wellness plans, whose profits rose inwards absolute terms as total revenues rose, could ride that wave. And that’s how it played out. Between 1998 as well as 2005, wellness tending premium grew threescore percent, or 2.4 times as fast as inwards the previous vii years. As terminal week’s Robert Wood Johnson study notes, premium growth betwixt 1996-2006 rose nearly 8 times as fast as the growth inwards personal income.
One of managed care’s to a greater extent than hare-brained ideas was slotting primary tending physicians (PCPs) as “gatekeepers.” This meant that, faced amongst a patient whose status warranted referral to a specialist, the PCP would probable lose touching amongst that patient’s care. Inside primary care, declining reimbursements translated to to a greater extent than patients, amongst less fourth dimension available for whatsoever 1 patient. Meanwhile, specialists enjoyed increasing pay as well as were rewarded for doing more, though non necessarily the right, procedures. The continuity of tending betwixt primary as well as specialty physicians gradually eroded until it was all but forgotten. One of wellness care’s major check-and-balance mechanisms was lost, as well as costs skyrocketed.
The evidence that primary tending should have got primacy inwards whatsoever wellness tending scheme is uncomplicated but compelling. Consider that nearly thirty percent of American physicians – position unit of measurement physicians, internal medicine physicians, pediatricians, as well as gynecologists – provide primary care, as well as that nearly seventy percent are specialists. In virtually every other developed nation’s wellness system, the ratio is precisely about reversed. Their costs are nearly one-half ours, as well as their lineament is typically as expert or better.
Primary care’s effectiveness inwards creating amend wellness at lower cost throughout a population is good documented inwards other wellness systems as well as inwards our own. Studies focused on the US also demo that to a greater extent than access to primary tending lowers mortality rates, but the same is non truthful for specialty care.
Sure at that topographic point are other factors that brand our costs higher – access to technologies, lifestyle issues, demographics, as well as a dozen to a greater extent than – but nix has as rigid or pervasive an influence as the straightforward human relationship betwixt the generalist as well as the specialist. If it is there, thence controls for reasonable tending are inwards place. Without it, as the Dartmouth Atlas has shown repeatedly, specialist as well as inpatient settings are rife amongst “unwarranted variation” – waste.
Onsite clinics are re-emerging into the American workplace at an astonishing rate. (Disclosure: I have got a human relationship amongst WeCare TLC, an onsite clinic fellowship based inwards Lake Mary, FL.) About one-third of Fortune 1,000 employers already have got clinics inwards place, as well as surveys demo that one-third to a greater extent than volition have got installed them past times the destination of 2010.
They are proliferating amid jumbo, large as well as mid-sized firms throughout the country. Although some less-than-astute consulting firms have got pronounced that they tin solely piece of work for firms amongst to a greater extent than than 1,000 employees, they are scalable when properly deployed. Many employers amongst as few as 150 employees have got implemented them successfully.
Onsite clinics typically provide comprehensive primary care. In most situations thence far, they sit down inwards forepart of, but are variety out from, the employer’s wellness plan. By investing inwards the clinic, the employer reduces wellness programme expenditures. This scheme industrial plant best when the employer's wellness programme is self-funded. In fully insured plans, the savings would accrue to the insurance fellowship rather than the employer. But fifty-fifty fully insured employers tin do goodness plenty from occupational wellness savings as well as employee morale to to a greater extent than than justify a clinic.
The best clinics are complex machines.
They:
They:
But the effectiveness of onsite clinics is also related to their convenience as well as to the trust they’re capable of engendering inwards patients. These characteristics allow them to larn fully-realized medical homes, places that patient experience comfortable turning to for tending at whatsoever time, as well as places, to borrow NCQA President Peggy O’Kane’s phrase, where the clinicians are thinking nearly the patients, whether or non they’re inwards forepart of the doctor.
In its most basic terms, a clinic is truly borne out of a covenant betwixt an employer as well as a doctor, using the clinic theatre as the vehicle, to do an end-around on the wellness plan. (Because effective clinics trim down wellness service utilization throughout the continuum, wellness plans may experience that they are, inwards part, disintermediated past times them.) The employer pays the physician to a greater extent than to larn to a greater extent than involved amongst each patient inwards the clinic as well as everywhere else that tending is needed. In render the employees as well as their families have amend lineament tending at lower cost.
But inwards my experience, employers investigating a clinic desire to sympathise why, structurally, a clinic volition improve tending as well as salve them money. The determination to implement is straight tied to their experience that, for whatever reasons, the wellness programme is NOT going to aid them trim down costs. They sympathise the reasoning that primary care, delivered from the clinic platform, volition hit amend results.
The explosive growth of onsite clinics is sensible. Within the twin dynamics of high cost wellness tending as well as an economical downturn, they trim down remove chances as well as cost, as well as render a solid render on investment. They create dramatic improvements inwards both lineament as well as cost – most study relatively rapid savings of 15-30 percent as well as reductions inwards annual cost growth – past times delivering preventive, primary care, chronic affliction management as well as needlelike tending coordination services that deport on both personal as well as occupational health.
Over the terminal brace years, CIGNA has emerged as a hotbed of innovation. At the conference a brace weeks ago, Ingrid Lindberg, who as CIGNA’s Chief Experience Officer leads its fellow member communications efforts, gave a terrific utter on their efforts to create clearer as well as easier communications for its members as well as target markets, leveraging modern pattern as well as Web-outlets similar YouTube, Facebook as well as Twitter. The other wellness programme representatives inwards the room were clearly impressed.
And thence I spoke to a national potency on wellness/prevention programs, who volunteered that CIGNA had come upwards rattling far as well as was possibly the most advanced wellness programme he’d seen inwards its implementation of wellness/prevention.
But it is CIGNA’s clinics that seem the most telling. In 2008, CIGNA opened clinics for its ain employees inwards 4 Eastern locations. Now, inwards 2009, it encourages employer clients amongst 1,000 or to a greater extent than employees to implement these structures.
Because clinics are such powerful platforms that integrate a broad diverseness of wellness tending functionalities, this motion could hold upwards interpreted as maxim 2 rattling of import things nearly CIGNA’s leadership as well as strategy:
If CIGNA paid primary tending physicians to a greater extent than to pass to a greater extent than fourth dimension amongst patients as well as to larn engaged inwards their downstream care, it could trigger the boost that primary tending needs. Providing leadership on this number could get the healing that primary tending thence desperately needs, as well as provide argue 1 time again for medical students to larn generalists. The empowerment of primary care, as well as the hunger of PCPs to hold upwards allowed to exercise to a greater extent than capably, could amplify CIGNA’s quality/cost management efforts.
These were such tantalizing prospects that, rather than precisely speculate, I called as well as spoke amongst Jeff Kang, MD, CIGNA's Chief Medical Officer. Dr. Kang told me that, iii years ago, CIGNA engaged inwards an enterprise-wide strategic endeavor that resolved to alter many aspects of its concern to optimize service for their customers. I’m paraphrasing here, but he said, “I know many companies volition enjoin yous this, but inwards our illustration it is true. We are non precisely reacting to the crisis. We were determined to brand an endeavor to larn the best wellness services organisation possible.”
Dr. Kang confirmed that CIGNA volition aggressively pursue its onsite clinic effort, that they do regard primary tending as well as medical homes as telephone substitution to creating improvements, as well as that they have got many plans inwards these as well as other areas. He emphasized that primary tending was solely 1 of many efforts.
The proof volition hold upwards inwards the results, of course. It is to a greater extent than than possible that other major wellness plans are headed inwards as innovative directions, as well as that I precisely am unaware of their efforts.
But, thence far, CIGNA appears to hold upwards sincere, focused as well as far ahead of other plans inwards creating a new, rattling powerful model of wellness tending delivery that does truly psyche the lessons of the terminal twenty years.
If they, or whatsoever wellness programme amongst similar aspirations, succeed, they volition have got the marketplace as well as alter the ways all American wellness plans operate.
And that would hold upwards expert word indeed for us all.
Brian Klepper is a wellness tending analyst based inwards Atlantic Beach, FL.
You are now reading the article Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics with the link address https://new-insurancequotes.blogspot.com/2019/08/will-cigna-remake-wellness-innovation.html
Title : Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics
Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics
Will CIGNA Remake The Health Plan Marketplace?by BRIAN KLEPPER
America’s health plans are floundering. If their chore has been to provide the nation’s mainstream families amongst access to affordable tending (let’s leave of absence lineament out of it for the moment), they have got failed miserably, though they were rattling profitable along the way, at to the lowest degree until Q1 2008. In 2008, the Milliman Medical Index – an approximate of the total cost for wellness coverage premium as well as out-of-pocket costs for a position unit of measurement of 4 – was $15,609. Now it is almost sure higher upwards $17,000, to a greater extent than than the total income of to a greater extent than than one-third of American households.
To many wellness programme execs, these are precisely marketplace dynamics that must hold upwards accommodated through novel production as well as service designs. I precisely attended a wellness programme conference where the overarching themes were the transition away from grouping to private coverage, as well as the exercise of incentives as well as touching points similar texting, email, as well as ergonomic Web interfaces to cultivate fellow member competency, loyalty as well as retention.
There are of import steps forwards but, to me, the give-and-take tiptoed about the to a greater extent than glaring job – costs this high have got exhausted many purchasers’ powerfulness to pay, as well as are chop-chop shrinking wellness plans’ commercial marketplace as well as profitability.
Several wellness programme execs at the conference pointed to the tending delivery as well as provide sectors as the drivers of cost, but that is, at to the lowest degree inwards part, also an evasion. As payers, wellness plans tin pattern incentives for to a greater extent than efficient tending delivery. They tin exert meaning pressure level on cost growth through many uncomplicated but demonstrably effective mechanisms:empowering primary care, leveraging marketplace forces past times making cost as well as functioning transparent throughout the wellness tending continuum, paying for results rather than for procedures.
But the harsh truth is that for nearly 10 years wellness plans, similar all major wellness tending sectors, have got focused on anything but cost management for a uncomplicated reason: it has been inwards their short-term fiscal interests for wellness tending to cost more. (Fully insured plans earn a per centum of total revenues. The large carriers who administer self-funded or ASO (Administrative Services Only) plans have got raised administrative fees as claims costs have got risen.) The job is that the long-term consequences of that strategy have got arrived.
It has been nearly a decade since, inwards Nov 1999, UnitedHealth Group announced that they were curtailing most utilization management activities. Their announcements said that the complexities of pre-certification had truly increased overall costs. And, of course, the physical care for was typically cumbersome as well as ofttimes idiotic, infuriating doctors as well as hospitals. In a sense, this instant signaled the transition out of the commencement major stage of managed care, at to the lowest degree as hopefuls similar me see of it, as well as into a menses of relative dormancy.
Like other wellness plans, United did a piteous chore conveying to employers as well as patients wellness care’s enormous waste product as well as fiscal conflict, or the seriousness of the approaches necessary to plow those problems around. The physicians’ rebuttal – that accountants as well as clerks, rather than doctors, were making wellness tending decisions – was good received inwards the marketplace. Ultimately, nearly all wellness plans followed suit. The Sun assault that era of aggressive medical management.
What remained unsaid, though, was that fewer controls over care, combined amongst a reimbursement scheme that rewarded to a greater extent than procedures, would accelerate overall cost growth, as well as that the wellness plans, whose profits rose inwards absolute terms as total revenues rose, could ride that wave. And that’s how it played out. Between 1998 as well as 2005, wellness tending premium grew threescore percent, or 2.4 times as fast as inwards the previous vii years. As terminal week’s Robert Wood Johnson study notes, premium growth betwixt 1996-2006 rose nearly 8 times as fast as the growth inwards personal income.
One of managed care’s to a greater extent than hare-brained ideas was slotting primary tending physicians (PCPs) as “gatekeepers.” This meant that, faced amongst a patient whose status warranted referral to a specialist, the PCP would probable lose touching amongst that patient’s care. Inside primary care, declining reimbursements translated to to a greater extent than patients, amongst less fourth dimension available for whatsoever 1 patient. Meanwhile, specialists enjoyed increasing pay as well as were rewarded for doing more, though non necessarily the right, procedures. The continuity of tending betwixt primary as well as specialty physicians gradually eroded until it was all but forgotten. One of wellness care’s major check-and-balance mechanisms was lost, as well as costs skyrocketed.
The evidence that primary tending should have got primacy inwards whatsoever wellness tending scheme is uncomplicated but compelling. Consider that nearly thirty percent of American physicians – position unit of measurement physicians, internal medicine physicians, pediatricians, as well as gynecologists – provide primary care, as well as that nearly seventy percent are specialists. In virtually every other developed nation’s wellness system, the ratio is precisely about reversed. Their costs are nearly one-half ours, as well as their lineament is typically as expert or better.
Primary care’s effectiveness inwards creating amend wellness at lower cost throughout a population is good documented inwards other wellness systems as well as inwards our own. Studies focused on the US also demo that to a greater extent than access to primary tending lowers mortality rates, but the same is non truthful for specialty care.
Sure at that topographic point are other factors that brand our costs higher – access to technologies, lifestyle issues, demographics, as well as a dozen to a greater extent than – but nix has as rigid or pervasive an influence as the straightforward human relationship betwixt the generalist as well as the specialist. If it is there, thence controls for reasonable tending are inwards place. Without it, as the Dartmouth Atlas has shown repeatedly, specialist as well as inpatient settings are rife amongst “unwarranted variation” – waste.
Onsite clinics are re-emerging into the American workplace at an astonishing rate. (Disclosure: I have got a human relationship amongst WeCare TLC, an onsite clinic fellowship based inwards Lake Mary, FL.) About one-third of Fortune 1,000 employers already have got clinics inwards place, as well as surveys demo that one-third to a greater extent than volition have got installed them past times the destination of 2010.
They are proliferating amid jumbo, large as well as mid-sized firms throughout the country. Although some less-than-astute consulting firms have got pronounced that they tin solely piece of work for firms amongst to a greater extent than than 1,000 employees, they are scalable when properly deployed. Many employers amongst as few as 150 employees have got implemented them successfully.
Onsite clinics typically provide comprehensive primary care. In most situations thence far, they sit down inwards forepart of, but are variety out from, the employer’s wellness plan. By investing inwards the clinic, the employer reduces wellness programme expenditures. This scheme industrial plant best when the employer's wellness programme is self-funded. In fully insured plans, the savings would accrue to the insurance fellowship rather than the employer. But fifty-fifty fully insured employers tin do goodness plenty from occupational wellness savings as well as employee morale to to a greater extent than than justify a clinic.
The best clinics are complex machines.
They:
- Fully empower the primary tending physician past times providing expert decision-support tools, past times allowing them to pass to a greater extent than fourth dimension amongst each patient, as well as past times encouraging them to collaborate amongst specialists on their patient’s downstream care. It is worth mentioning that doctor-based clinics ofttimes seek to supervene upon the tending available on the wellness programme network, piece nurse-based clinics typically are nearly supplementing the wellness plan’s care.
- Incorporate incentives that encourage physician functioning as well as clinic exercise past times employees as well as their families.
- Use a total complement of internal wellness information technology tools – wellness information exchange, information repositories, analytics to position patients amongst risk, analytics to behaviour provider profiling, electronic wellness records, decision-support, internal functioning monitoring – to contend clinical as well as administrative processes, as good as external tools – Web-based scheduling, personal wellness records, incentive as well as engagement programs, as well as linkages to consumer-facing Health 2.0 sites – that aid patients larn to a greater extent than involved inwards as well as aware of their ain wellness as well as care.
- Develop creative purchasing arrangements for high cost items similar drugs, labs, as well as equipment.
- Offer onsite health/disease/lifestyle management using trained nurse coaches.
They:
- Exchange higher wellness programme costs for routine tending for much lower costs within the clinic. For example, costs for physician visits, drugs as well as labs provided through the clinic tin hold upwards a fraction of what they to a greater extent than ofttimes than non cost through the plan.
- Provide face-to-face management of patients amongst chronic disease, who eat as much as seventy percent of a typical population’s wellness costs.
- Facilitate the collaborative management of patients who remove specialty as well as inpatient care.
- Integrate personal heatlh services amongst those for occupational wellness – workers’ compensation, human resources testing (like pre-employment screening, drug screening, Department of Transportation exams), retentivity as well as recruitment, as well as productivity (absenteeism as well as presenteeism).
But the effectiveness of onsite clinics is also related to their convenience as well as to the trust they’re capable of engendering inwards patients. These characteristics allow them to larn fully-realized medical homes, places that patient experience comfortable turning to for tending at whatsoever time, as well as places, to borrow NCQA President Peggy O’Kane’s phrase, where the clinicians are thinking nearly the patients, whether or non they’re inwards forepart of the doctor.
In its most basic terms, a clinic is truly borne out of a covenant betwixt an employer as well as a doctor, using the clinic theatre as the vehicle, to do an end-around on the wellness plan. (Because effective clinics trim down wellness service utilization throughout the continuum, wellness plans may experience that they are, inwards part, disintermediated past times them.) The employer pays the physician to a greater extent than to larn to a greater extent than involved amongst each patient inwards the clinic as well as everywhere else that tending is needed. In render the employees as well as their families have amend lineament tending at lower cost.
But inwards my experience, employers investigating a clinic desire to sympathise why, structurally, a clinic volition improve tending as well as salve them money. The determination to implement is straight tied to their experience that, for whatever reasons, the wellness programme is NOT going to aid them trim down costs. They sympathise the reasoning that primary care, delivered from the clinic platform, volition hit amend results.
The explosive growth of onsite clinics is sensible. Within the twin dynamics of high cost wellness tending as well as an economical downturn, they trim down remove chances as well as cost, as well as render a solid render on investment. They create dramatic improvements inwards both lineament as well as cost – most study relatively rapid savings of 15-30 percent as well as reductions inwards annual cost growth – past times delivering preventive, primary care, chronic affliction management as well as needlelike tending coordination services that deport on both personal as well as occupational health.
Over the terminal brace years, CIGNA has emerged as a hotbed of innovation. At the conference a brace weeks ago, Ingrid Lindberg, who as CIGNA’s Chief Experience Officer leads its fellow member communications efforts, gave a terrific utter on their efforts to create clearer as well as easier communications for its members as well as target markets, leveraging modern pattern as well as Web-outlets similar YouTube, Facebook as well as Twitter. The other wellness programme representatives inwards the room were clearly impressed.
And thence I spoke to a national potency on wellness/prevention programs, who volunteered that CIGNA had come upwards rattling far as well as was possibly the most advanced wellness programme he’d seen inwards its implementation of wellness/prevention.
But it is CIGNA’s clinics that seem the most telling. In 2008, CIGNA opened clinics for its ain employees inwards 4 Eastern locations. Now, inwards 2009, it encourages employer clients amongst 1,000 or to a greater extent than employees to implement these structures.
Because clinics are such powerful platforms that integrate a broad diverseness of wellness tending functionalities, this motion could hold upwards interpreted as maxim 2 rattling of import things nearly CIGNA’s leadership as well as strategy:
- First, it suggests that CIGNA has broken from the conventional thinking amid wellness plans as well as decided to pursue actions that tin significantly drive downward overall claims costs.
- Second, it suggests that CIGNA has decided to dorsum the primacy of primary care, as well as could create fiscal incentives for primary tending coordination that would hold upwards available to community-based PCPs.
If CIGNA paid primary tending physicians to a greater extent than to pass to a greater extent than fourth dimension amongst patients as well as to larn engaged inwards their downstream care, it could trigger the boost that primary tending needs. Providing leadership on this number could get the healing that primary tending thence desperately needs, as well as provide argue 1 time again for medical students to larn generalists. The empowerment of primary care, as well as the hunger of PCPs to hold upwards allowed to exercise to a greater extent than capably, could amplify CIGNA’s quality/cost management efforts.
These were such tantalizing prospects that, rather than precisely speculate, I called as well as spoke amongst Jeff Kang, MD, CIGNA's Chief Medical Officer. Dr. Kang told me that, iii years ago, CIGNA engaged inwards an enterprise-wide strategic endeavor that resolved to alter many aspects of its concern to optimize service for their customers. I’m paraphrasing here, but he said, “I know many companies volition enjoin yous this, but inwards our illustration it is true. We are non precisely reacting to the crisis. We were determined to brand an endeavor to larn the best wellness services organisation possible.”
Dr. Kang confirmed that CIGNA volition aggressively pursue its onsite clinic effort, that they do regard primary tending as well as medical homes as telephone substitution to creating improvements, as well as that they have got many plans inwards these as well as other areas. He emphasized that primary tending was solely 1 of many efforts.
The proof volition hold upwards inwards the results, of course. It is to a greater extent than than possible that other major wellness plans are headed inwards as innovative directions, as well as that I precisely am unaware of their efforts.
But, thence far, CIGNA appears to hold upwards sincere, focused as well as far ahead of other plans inwards creating a new, rattling powerful model of wellness tending delivery that does truly psyche the lessons of the terminal twenty years.
If they, or whatsoever wellness programme amongst similar aspirations, succeed, they volition have got the marketplace as well as alter the ways all American wellness plans operate.
And that would hold upwards expert word indeed for us all.
Brian Klepper is a wellness tending analyst based inwards Atlantic Beach, FL.
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You are now reading the article Will Cigna Remake The Wellness Innovation Marketplace?--Cigna Embraces Onsite Clinics with the link address https://new-insurancequotes.blogspot.com/2019/08/will-cigna-remake-wellness-innovation.html
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