Cigna’s US president on the persistent situation burden reshaping employer well being technique
Are you the dealer your purchasers really want proper now?
It’s a query price considering, in line with Bryan Holgerson, president of Cigna Healthcare US in Bloomfield, Connecticut, who says the group advantages market has entered a interval the place the hole between brokers who genuinely perceive their purchasers’ workforce and those that are merely renewing plans on autopilot has by no means been wider – or extra consequential.
Holgerson has spent 26 years at Cigna Healthcare, the final three as president of its US enterprise, in roles spanning gross sales, implementation, and account administration throughout giant, midsize, and small employer markets.
Talking to Insurance coverage Enterprise Advantages US at the beginning of open enrollment season, he provided a transparent evaluation of the forces bearing down on employer-sponsored well being plans and what brokers should do to remain forward of them.
A workforce getting sicker – and costlier
Holgerson mentioned that the muse of the fee downside will not be inflation or consolidation alone; it’s the deteriorating well being of the working-age inhabitants.
He cited 2025 figures from the U.S. Facilities for Illness Management and Prevention exhibiting that greater than 75 p.c of Individuals between the ages of 35 and 64 presently have at the very least one persistent situation. Forty p.c carry two.
“These are wild stats,” he mentioned. “And people are people which might be actively at work, that employers are relying on for productiveness – they usually’re challenged with not solely issues exterior life and all of the issues that include having a household, however their very own well being as nicely.”
To that persistent situation burden, he added three additional strain factors: inflation, trade consolidation, and pharmaceutical innovation. On that final level, he was cautious to separate the societal profit from the monetary actuality.
The identical breakthroughs producing what he known as “miracle medication” – customized remedies designed for a person’s particular biology – carry analysis and improvement prices that may detonate a small employer’s advantages price range.
“If you concentrate on a small employer with 100 staff who must both insure or self-insure their inhabitants, 1,000,000 or a $2 million drug will not be one thing that they’ll simply take up within the regular variation of their advantages price range,” he mentioned.
Not like conventional front-loaded analysis cycles, the tempo of drug innovation means every new wave of remedies restarts the fee spiral. Synthetic intelligence could ultimately compress improvement timelines, however it is not going to eradicate the structural strain on plan sponsors.
The blind spots plan sponsors can not afford
With open enrollment conversations occurring throughout the nation, Holgerson highlighted the place employers and their brokers are most uncovered.
The primary blind spot is specialty drug spend. Plan sponsors are largely conscious of the price of particular person medication, he mentioned, however few have a reputable plan for what that mixture trajectory appears like 5 years from now as a societal burden. Speciality drug prices had been just lately highlighted by Paul Fronstin, Ph.D., director of well being advantages analysis on the Worker Profit Analysis Institute, in an interview with IBB.
The second problem for brokers and their purchasers, and in Holgerson’s view extra systemic, is persistent situations.
Based on information introduced by the Cigna Group at its 2026 Investor Day, eight p.c of sufferers with complicated care wants account for 55 p.c of whole healthcare spending and that share compounds as situations worsen and go unmanaged.
“It’s a snowball that simply retains persevering with to go as people get sicker and sicker,” Holgerson mentioned. “And that’s why the employers which might be doing the very best proper now actually have a full inhabitants well being technique. They’re not simply managing renewal to renewal.”
Why elevating deductibles is now not sufficient
Holgerson traced a multi-decade sample during which employers used greater deductibles and out-of-pocket maximums as their major cost-containment lever. It’s a technique that works mathematically however which, he argued, is basically damaged as a long-term method.
“The one piece that it does not remedy, particularly as people get sicker, is that what’s actually necessary is them really being on the proper path and the proper journey for them to get the very best final result,” he mentioned. “And everyone knows that the very best final result from a well being standpoint results in finally the bottom price.”
He pointed to a significant shift already seen within the conversations Cigna is having with main employers. More and more, plan sponsors inform him they’re prepared to waive deductibles and out-of-pocket maximums totally for workers with persistent or complicated situations, supplied these people observe an outlined care path: seeing a high-performing doctor, staying compliant with medicines, attending follow-up care.
Holgerson cited research estimating that greater than 30 p.c of spending within the US healthcare system represents waste, which he sees because the addressable alternative that justifies investing in navigation and inhabitants well being reasonably than additional cost-shifting to staff.
Expertise retention is reshaping the calculation additional. Most employers, he mentioned, now view their staff as one in all their largest property. Meaning poor advantages outcomes – absenteeism, medical depart, attrition – carry recruitment and coaching prices that always wipe out any financial savings achieved by means of leaner plan design.
“For those who may also help a person that has a persistent illness go on the proper path – so long as they’re seeing a high-performing doctor, getting their follow-up care, staying compliant with their medicines – I’d be prepared to forego deductibles and out-of-pockets,” he mentioned. “It is simply such an enchanting flip that is been taken.”
Navigating the complexity with HealthSense
Cigna’s HealthSense platform is designed to handle two of essentially the most persistent failure factors in the advantages system: the person’s expertise navigating their protection, and the waste generated by a fragmented care journey.
Holgerson used a concrete instance for instance the issue HealthSense is constructed to resolve. When a affected person is discharged from hospital, they face on common 4 follow-up visits with 4 completely different physicians. With out steering on the place to go first – and how you can carry related data between suppliers – care turns into siloed, outcomes undergo, and prices rise.
“HealthSense will not be attempting to diagnose a person,” he mentioned. “However what it is making an attempt to do is to usher in the details about a person – each their advantages data and their well being data – and provides them steering when it comes to the following steps and issues they need to contemplate.”
He linked the platform’s relevance on to the accelerating shift towards self-funded plan buildings.
As employers transfer from absolutely insured preparations towards self-funded, level-funded, or Particular person Protection Well being Reimbursement Account (ICHRA) fashions, the decision-making burden more and more falls on staff who’re unfamiliar with navigating prices and protection, usually whereas their family budgets are already stretched.
The dealer differentiator: human capital technique
Brokers at the moment are anticipated to advise throughout pharmacy advantages, psychological well being parity compliance below the Psychological Well being Parity and Habit Fairness Act, plan analytics, and Worker Retirement Earnings Safety Act (ERISA) fiduciary obligations.
That is nicely past conventional placement work however Holgerson mentioned that whereas the fundamentals are non-negotiable they’re now not adequate. Understanding fiduciary duty, setting sound budgets, and delivering stable plan analytics are what he described as needing “a ticket to the dance.”
The actual differentiator is one thing more durable to commoditize – understanding every employer’s human capital technique and tailoring profit design round it.
“There are some employers that will be very turned off with ICHRA if a advantages dealer introduced it in,” he mentioned. “Identical factor with the whole inhabitants well being technique. There are some employers who view that as being actually necessary due to the coaching prices, due to changing a employee. Others will not view it that method.”
Know-how is accelerating that chance. Synthetic intelligence and analytics instruments are enabling brokers to synthesize giant information units into actionable levers far quicker than was beforehand potential – a functionality that turns into particularly essential as extra purchasers transfer to self-funded fashions and achieve entry to claims information they by no means had below absolutely insured preparations.
The funding employers have to make
Holgerson’s closing message was aimed as a lot at employers as at their brokers.
The reply to the fee disaster is to not spend extra money, he mentioned. It’s to spend extra strategically and to interact extra deeply with the advisors and well being plans that may assist them do it.
“For those who had been asking me, what would you encourage an employer to do completely different now versus what they might have accomplished 10 and 15 years in the past?” he mentioned. “It is really making extra investments – not from a greenback standpoint, however from a technique standpoint – and dealing collaboratively with their dealer and their well being plan. As a result of the extra that an employer places into it, the extra worth that they’ll get out.”
For brokers, that’s each a problem and a possibility. The employers who perceive what’s at stake are actively searching for advisors who may also help them suppose in another way about their workforce well being. The query is whether or not the dealer sitting throughout from them is able to have that dialog.
