Meet Julie McCarter, leader of Cigna's strategy for behavioral, wellness and virtual

Steven Loeb · February 18, 2020 · Short URL: https://vator.tv/n/4fa1

She helps employers create new digital health packages

While most entrepreneurs want to be the one to discover the next Amazon or Twitter, oftentimes major technological shifts are coming from the big companies, the players that have been on the scene for years, if not decades. Those companies have survived because they know how to pivot. They're the ones who either seed new ideas or acquire them and distribute them. 

In this column, we talk to those companies and their innovators who are preparing them for what's coming.

In our latest interview, we spoke to Julie McCarter, VP of product solutions at Cigna about some of the innovations the company has been making in the areas of virtual and telehealth.

McCarter is responsible for strategic, financial and operating performance of the core medical, access, care management, behavioral, health and wellness and incentive solution lines for Cigna's US commercial business.

Prior to this role, she was responsible for strategic efforts including strengthening Cigna's ability to create local market win strategies to drive top-and-bottom-line results reflective of reality that healthcare is local. Additionally, McCarter has held roles focusing on product strategy for employer sponsored markets, differentiating Cigna as an industry innovator, developing plan designs with customer-focused solutions, and finding new ways to create value within the US employer marketplace.

McCarter joined Cigna in 2008 when Cigna acquired Great-West Healthcare where she was responsible for the Product Organization. It was during this tenure that she and her team launched the first generation Level Funding product, a self-funded product for smaller employers in the US, which has become a cornerstone of Cigna’s Select Segment growth success. Prior leadership rotations included roles in Operations and Network Development. 

She holds a BA in Psychology from the University of Colorado, Boulder.

VatorNews: Tell me a bit about yourself, your background and your role at Cigna.

Julie McCarter: I’ve been in health care for over 25 years, and right now I’m the vice president of product solutions at Cigna. Essentially, I lead strategy and development for Cigna’s health care solutions for U.S. employers. Sometimes that feels like industry speak, so I say it this way: when U.S. employers seek to create benefit packages to attract and retain their talent, they think about medical solutions, clinical programs, behavioral solutions, health and wellness incentives and virtual capabilities. Those are the products that my team and I create and maintain for U.S. employers. 

VN: What’s important to U.S. employers in virtual care right now?

JM: When it comes to virtual services, often times employers are looking to continue to make healthcare more affordable for their employees and families, as well as for themselves. So, first and foremost, this is about creating solutions that deliver care in an affordable way, as well as the opportunity for virtual services to expand really important access points for employees and their families. 

It’s about affordability and access, and that’s why we spend a lot of time thinking about virtual services that exist today, and how we can continue to expand those services for our customers.

VN: How important is virtual care to Cigna? What kind of opportunities do you see in this space?

JM: Since 2014, we’ve offered virtual care for urgent services, it’s an easy and affordable access point for simple medical conditions. 

More recently, Cigna has expanded virtual services into the behavioral health space. There are approximately 44 million Americans who suffer from a mental health condition and they may be facing anything from the stigma around treating that condition to access and affordability challenges. So, on January 1, 2020, we worked with MDLIVE to expand Cigna’s virtual services in the behavioral health space. 

We’re also working with MDLIVE to create wellness services through a virtual mechanism. A large portion of the population does not have an existing primary care physician relationship, and we think that by offering a convenient and comfortable access point virtually, we can help them start their health care journey. 

So, we started with urgent care, a convenient and affordable way for people to gain access to services for simple things like strep throat or a cold that won’t go away. That expanded into behavioral, and now wellness services. We see more opportunities as well.

VN: How do you see virtual care changing the doctor/patient relationship?

JM: Cigna doesn’t view virtual as a replacement to well established patient-physician relationships, and for those who have well-served, enduring relationships in place today, we absolutely want them to continue that.  Virtual care is an incredible addition that helps customers without those relationships, and provides a solution to access challenges that exist across certain specialties, like behavioral.

In addition to that, I think about the opportunity we have, and I’m spending a lot of time thinking about this, to lift customers up and start them on a health care journey. We can do that in a virtual way. 

So, it’s a starting point, and when people enter virtual care and have additional needs, whether it’s biometric results that look somewhat concerning, or questions that are not well addressed in a virtual way, it becomes an effective referral opportunity for us to get patients into our high-performing specialist network. 

VN: It’s interesting that you talk about those new relationships. In your opinion, from what you’ve seen, is it important for patients to have an initial meeting in person?

JM: I don't think it’s as simple to say there’s one answer, because it can depend on the person and the clinical indications. A fair number of us are perfectly served by having a virtual conversation with a physician who has a wealth of information from biometrics such as bloodwork, blood pressure, and waist circumference. These metrics can be really indicative of a person’s health, so an initial virtual experience can be a great starting point for a large portion of our customers.  

VN: Let’s say a person has a chronic illness or something like that, would that be a case where an in-person visit would be more beneficial to that patient? 

JM: This is actually something that we view as an opportunity ahead of us. We invested in Buoy Health, for example, so I’m going to tie this answer to that capability. 

Cigna Ventures’ investment in Buoy Health, which is an AI-powered engine around diagnosing and triaging people to effective care paths, gets exactly at what you’re asking about. We have this opportunity to help people in a convenient way, understand their health questions, and then course them, as effectively as possible, into care. That could be, ‘You have said enough to me to indicate that it would be great for you to see a physician of this specialty, let us help you do that,’ or, ‘We can do more virtually together.’ 

VN: Walk me through how patients use Cigna Telehealth Connection. What’s the goal? How does it work?

JM: Cigna Telehealth Connection is the label that we’ve used to tell our U.S. commercial population that they have access 24/7 to urgent care services virtually. 

We brought our MDLIVE urgent care solution to Cigna customers in 2014. What’s interesting is that urgent care services are relatively low utilized, and what we’ve been working on recently is building awareness. To start, we’ve redesigned the digital experience that our customers step into when they enter MyCigna.com. By making the tool more prominent, we’ve seen 48 percent more traffic to our virtual care page. 

It’s important for us to make the urgent care services capability available for our whole population and continue to modify the digital design within MyCigna.com so people are aware of the capabilities available to them. 

VN: What kinds of benefits do patients see by using Telehealth Connection? Do they save money or do they see increased health benefits? 

JM: We spend a great deal of time studying the effectiveness of these services. 

A recent study looked at 20,000 Cigna customers who had used MDLIVE, and 20,000 who had not used MDLIVE, and we saw that virtual care users had 17 percent lower total medical costs than their non-virtual user cohorts. So, just right there, we can see top line savings across a population using virtual versus a population not using virtual. 

We also spend a lot of time looking at emergency department visits. As you can imagine, these are oftentimes unnecessary and costly visits. So, virtual care can be an effective alternative. When using virtual care, we found a 36 percent net reduction in emergency department use per 1,000 people, as compared to non-virtual care users. Lower emergency room utilization is an important metric. We also found that those who use virtual care have an approximate 45 percent higher use of generic medications. 

There are important metrics that show that using these services can help people save money.

VN: That’s really interesting what you said about generic medication, and I hadn’t heard that before. How does using virtual service lead to more generic medication? Why would a doctor prescribe a generic during a virtual visit and not during an in-person visit?

JM: It’s a good question and I can theorize as to some possibilities, but we need to continue to dig into our studies to better understand. At a headline level, it’s really important for us to see higher generic utilization.

It is important that virtual services are affordable to use; to that end, we include a service expectation that MDLIVE dispenses generic drugs nearly all of the time when prescribing drugs for patients. This is an expectation they deliver on consistently.

VN: You’ve talked a lot about the partnership with MDLIVE. I want to understand what they provide for Cigna and what you provide for them. How exactly does the relationship work?

JM: When a customer enters MyCigna.com, we’re able to single sign on customers to the MDLIVE experience. From there, MDLIVE registers the Cigna customer into the process, connects them with a provider and takes care of them clinically. 

So, MDLIVE is really the clinician behind the scenes and the digital interface for the customer to enter that clinical relationship. 

VN: In December, you expanded your partnership with MDLIVE to include mental and behavioral health, which you mentioned to me earlier. Why was mental health an area that was important for Cigna to expand telehealth services to? And is it different in any way because of stigma and privacy issues around mental health?

JM: While prevalence is the same, it feels to me that people are becoming more aware that they need to access mental health help. So it’s important for us to better understand mental health challenges and how they manifest, especially from a whole person health perspective. In addition, the demand for mental health services has elevated. 

With awareness and demand increasing, we realize there is a real challenge in the U.S. to access behavioral health practitioners. Whether it’s finding a provider or being seen in a timely and convenient manner, the opportunity to make this solution available virtually for customers was really important. So, that move on 1/1/20 was a big milestone for us.

As far as the entry point, it’s actually very similar to what I described earlier. In our MyCigna.com experience, we have a guided search tool that can indicate a mental health need. Through the tool, we present choices: do you want to seek virtual care for this? Do you want to go physically see a person? As we present out those choices, a person can select virtual services, and then they are launched back into the secure environment of MDLIVE, where they can register, select a practitioner and make an appointment.

VN: Beyond behavioral and mental health, what are some other areas you’d like to expand into when it comes to virtual care?

JM: You’ll continue to see more activity from Cigna on this front. As we continue to evolve this wellness visit opportunity, it’s a stepping stone to virtual primary care and creating enduring relationships in a virtual care team for people. We also know that there are opportunities to expand virtual services for certain specialties, and opportunities for simple chronic condition management to happen in a virtual setting as well. 

To give an example, MDLIVE has specialty capabilities in the space of dermatology. When I learn more about those capabilities, I’m intrigued that the most common conditions to serve people virtually are psoriasis and acne. From a convenience standpoint, it makes sense to have these services delivered virtually. 

VN: Is there anything else that I should know about Cigna or your efforts in this space?

JM: We view virtual care as transformative in how Cigna customers can connect to affordable, predictable, simple care in a convenient way to meet their needs. We’re excited about the solutions we have now and are looking forward to exploring the other opportunities that exist.

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