AI @ Cigna

Cigna announced a new transparent health plan called Clearity, integrating access to their AI assistant providing personalized, clear answers to coverage and cost questions, aiming to enhance member experience and transparency.

• Fierce Healthcare: Cigna to launch new transparent health plan called Clearity

Cigna's new AI-driven Evaluation and Management Coding and Accuracy Reimbursement Policy to automatically downcode high-level claims using AI faced criticism from providers fearing inaccurate reimbursements and increased administrative burden. Meanwhile, Cigna expanded nationwide coverage for AI-powered cardiovascular imaging software from Heartflow and Cleerly, reflecting growing support for AI in precision cardiology and improved diagnostic value.

• AABC: AABC Urges Cigna to Reconsider New AI Driven Reimbursement Policy
• Radiology Business: Cigna will cover CT imaging artificial intelligence software nationwide
• Cleerly Health: Cigna Approves Coverage for Cleerly's AI Cardiovascular Imaging

Cigna unveiled industry-leading generative AI-powered digital tools, including an AI virtual assistant providing personalized, conversational responses for benefits, claims, and care questions. Early adoption rates were strong (67% proactive use, 80% helpfulness). Additional AI tools like personalized provider matching, cost tracking, and smart claim submission were introduced, aiming to simplify health insurance navigation and improve customer experience. Simultaneously, lawsuits over AI-driven benefit denials proceeded, reflecting ongoing controversy.

• PR Newswire: Cigna Healthcare Unveils Industry-Leading AI-Powered Digital Tools for a Simple and Reliable Customer Experience
• Yahoo Finance: Cigna (CI) Unveils AI-Powered Tools to Enhance Customer Experience
• Yahoo Finance: Cigna launches generative AI assistant for members
• Stock Titan: Cigna Launches AI-Powered Healthcare Tools With 80% Customer Satisfaction
• Healthcare Finance News: Cigna announces AI-powered virtual assistant among other digital tools

Continued criticism surfaced regarding Cigna using AI for claim rejections, according to legal and media reports, raising questions about fairness and accountability.

• WABE: Law firm suing three major health insurance companies for wrongfully rejecting claims with AI

Expanded AI applications focused on pharmacists monitoring medication adherence, inventory management, prediction of drug interactions, and reducing providers' administrative burdens; strong emphasis on ethical AI governance.

• Cigna Global Expat Health Insurance: AI in health care
• Cigna Global: Embracing AI and Machine Learning in Health Care
• Cigna Healthcare Newsroom: Digital transformation in health care: Powering precise care

Cigna reported multiple AI use cases including enhancing customer service via predictive analytics and personalized healthcare solutions, demonstrating ongoing AI integration.

• PitchGrade: Cigna: AI Use Cases 2024

Legal scrutiny intensified over Cigna's AI-driven claims denial practices while the company also promoted AI-driven process improvements to streamline claim payouts with compliance.

• AFS Law: Health Insurers Sued Over Use of Artificial Intelligence to Deny Claims
• AI Expert Network: Case Study: How Cigna is Transforming Health Insurance and Patient Care with AI

Cigna expanded AI use in internal recruiting to boost employee hiring and introduced AI for claim assessment and denial processes. However, multiple lawsuits emerged alleging unfair claim denials powered by AI algorithms. The company also explored generative AI’s role in self-diagnosis, while committing publicly to ethical AI governance.

• HR Brew: How Cigna used AI to revamp its internal recruiting system
• Axios: Cigna suit brings AI and algorithm complaints to healthcare
• The Cigna Group Newsroom: The Cigna Group's approach to ethical AI practices

Cigna utilized data and AI-driven analytics to improve patient outcomes, emphasizing outcome-driven insights without changing diagnoses directly.

• Cigna Newsroom: Cigna Uses Data and AI to Improve Patient Outcomes

Cigna expanded AI applications to identify treatment gaps, specifically monitoring patient medication adherence for chronic diseases.

• WSJ: Cigna Uses AI to Check if Patients Are Taking Their Medications

Cigna began leveraging AI to tackle healthcare challenges and improve whole-person care. In Q4, it expanded AI to monitor patient medication adherence, particularly for chronic diseases.

• Managed Healthcare Executive: Cigna Leverages AI
• WSJ: Cigna Uses AI to Check if Patients Are Taking Their Medications