On this week’s episode of Fortune’s Leadership Next podcast, co-hosts Alan Murray and Ellen McGirt talk with Dave Cordani, CEO of Cigna, about the growing understanding by CEOs everywhere that they need to pay more attention to mental health services for employees; the definition of vitality and the role it plays at Cigna today; and the need for health care services that offer personal connections between patients and doctors. They also discuss Cordani’s dedication to his own health, including daily morning workouts no matter where he is in the world.
Listen to the episode or read the full transcript below.
Alan Murray: Leadership Next is powered by the folks at Deloitte, who, like me, are super focused on how CEOs can lead in the context of disruption and evolving societal expectations. Welcome to Leadership Next, the podcast about the changing rules of business leadership.
I’m Alan Murray, and—you’re laughing already, Ellen—I’m here with my fantabulous co-host, Ellen McGirt. Ellen, hope you’re feeling healthy. I hope you’re feeling well. And I hope you’re feeling vital.
Ellen McGirt: I am feeling all of these things, and not just because I’m in proximity to greatness today, but also because I work in a place where I can bring my whole self to everything that I do. So I’m feeling very fulfilled. Alan, how about you?
Murray: I feel exactly the same way. It could have to do with it’s Monday. So I’m glad we’re both at the top of our game because we have a health care expert with us today. He is Dave Cordani, who is the CEO of Cigna. We’ve wanted to do this, Ellen and I both wanted to do this for a long time. Thank you so much for taking the time to be here. By the way, folks, he is in studio.
Dave Cordani: Good to be with you all. A lot of energy. A lot of energy to chase here. I’ve got to get up my game.
Murray: Get ready, get ready. Here we go. So you were at the Fortune Brainstorm health conference back in May. And I remember sitting there listening to you thinking, boy, it sounds like we are on the cusp of a revolution in primary care. I remember one of the things you said was that we’re changing the paradigm. So instead of you going to get health care, thanks to data, new technology, health care is going to come to you. Explain that.
Cordani: So if you think about the health care delivery equation for most people, they access health care oftentimes when in need of health services because of sickness, less for preventative. And secondly, we physically go to a place to access health care, so it’s less convenient, it’s a bit delayed, sometimes it’s fragmented. Technology presents an opportunity to expand on that. So to bring health care more real time personal, connected to an individual, oftentimes through virtual care, or reenvisioning what could happen in the home aided by technology, not to disintermediate or cut out interaction between a physical physician but to extend that from that standpoint.
And we’ve already seen some tremendous innovation relative to that within our company through our MD live programs, through our integrated virtual care programs, through new depression and anxiety programs that again, extend the care equation to programs that are in flight already. If you look at just virtual care or virtual care services are up about 20% for the first nine months of this year versus the first nine months of last year and we all know virtual care was up significantly last year because of COVID. Our new depression and anxiety program is already in the market. A new musculoskeletal program that has digital interaction in virtual interaction is in the market today as we speak. So it’s upon us now and it will continue to grow and evolve. The important part is to do it patientcentric and with the medical professionals, not technology centric or in spite of the medical professional, so patientcentric or customercentric and coordinating with the medical professionals.
McGirt: This is fantastic information. I mean, clearly the pandemic was the best use case for for virtual medicine. If you were not a believer, I certainly am now. I’m curious about two things. One is how is this going to play out in communities that are already underserved by by access to health care. Can this be something that can replace medical infrastructure? Will they be able to have access?
Cordani: So if we think about areas that have less access, let’s look at it through a couple lenses. First, let’s go rural. From a rural standpoint, we typically have less access to a variety of services. This is an opportunity to extend services and bring them into rural locations. And extend best in class medical providers whether they’re primary, behavioral, certain specialists, etc. Secondly, we can reenvision what takes place in inner cities through youth centers, through community centers, etc. and create kiosks where it may not be as convenient to be literally in the home from a technological standpoint, but having the additional access. And then lastly, through the virtualization, the advent of mobility, mobile mobile devices exist almost everywhere. So yes, it is an extender.
It’s not a silver bullet but if you think about it, maybe we have a shortage of medical behavioral professionals in some geographies. But if we use technology to extend those individuals, you’re able to manage that shortage or create some level of balance from a supply standpoint. So we see it as an equalizer or an extender of services for subsets of the population or subsets of the geographies that don’t have access to the care they need today.
McGirt: My follow-up then is the enormous body of work and research that you’ve been you’ve been collecting for a while. It sounds like the way we’re talking about this is brand new, but I know that you’ve been thinking about this for a long time. I want to highlight your loneliness research, your resilience research and in the most recent research, particularly on the mental health of girls and young women coming out of the pandemic. First of all, tell us about this research and how it builds on itself and how do you use it to make investment decisions.
Cordani: As an organization we’re guided by a mission and it’s important step back and be instructed by that. Our mission is to improve the health well-being and peace of mind of those we serve. So guided by our mission multiple years ago, we stepped back and said, we believe there’s a societal issue, and we talked about it in terms of loneliness, but we didn’t want to theorize that, we wanted to study and measure it. So we collaborated, which is what our company does, we partner and collaborate with academics and researchers, etc. And fielded quite interesting and somewhat disturbing research that tells us in the United States we have a loneliness epidemic. And we’re able to see that about 50% of people have somewhat high levels of loneliness and our youth are the most lonely from that standpoint.
We then did a body of work around resilience and we understand resilience is one’s ability to, if you will bounce back from challenges, to oversimplify And historically, resilience would dip for young teens, goes down troughs and comes back up. With the pandemic it started to decrease earlier, trough was deeper and it lasted longer. And you attach it to the back end of your statement that instructed us to see that during COVID we saw a 51% increase of young ladies teens presenting in emergency rooms for attempted suicide. And a program we’ve already referenced previously was our depression and anxiety programming virtual virtually online depression anxiety program, because you need to bring the service immediately to somebody and having matching capabilities that we can best match an individual to a therapist through the use of data. So more real time, you don’t have to wait two or three weeks for an appointment. Higher probability that the first person you’re interacting with you have a match with and then then you have an opportunity for continuity. So back to guided by our mission. We continue to be instructed by where and how can we best understand life and how we could help to maintain and or improve someone’s quality of life as we talk to her about health, well-being and peace of mind
Murray: That 50% increase in suicide attempts by teenage girls. That’s a scary number. Are you succeeding in reaching those goals?
Cordani: So we think health care is personal. And all health care is local. So as a large global health service company that has 190 million customer relations around the world, we now need to boil that down to one person at a time. So yes, we are but it’s a journey. That’s not a way of describing away the challenge. It’s a matter of leaning into the challenge. It’s one person at a time highly localized, supporting our medical professionals, supporting our employers and expanding the reach of programs so we can interact with people earlier in their need state as opposed to later in their need state when it’s more catastrophic.
Murray: I wanted to get to the mental health piece a bit more because you deal primarily as an employer-provided health care insurance, correct? I have to tell you, I mean, this is something that we had a group of CEOs in in Florida just last week, and this was top of mind for many of them. This is something that in terms of CEO awareness has exploded during the pandemic. Maybe it was there before, but it’s getting a lot more attention now. Do we have the programs in place to deal with an epidemic of mental health problems?
Cordani: Before we jump in a little bit, yes, we serve individuals through employers through our benefits program, as well as through our Evernorth services. We’re also a large provider of services to other health plans through our Evernorth services. We’re the largest provider of services like mental health, virtual care, care coordination, especially pharmaceuticals, other health plans. Also to governmental agencies like the Department of Defense and then increasingly physician-lead organization from that standpoint. So we serve a broad swath all with the objective of touching more lives.
Back to from an employer standpoint, you’re absolutely right, Alan. Employers now have this front and center, they understand the impact. They see the impact. The impact is actually driven by an understanding of workplace engagement, presenteeism, productivity, turnover. They can now see the data to say that if someone is dealing with a mental health challenge himself or in the family unit, they carry that into the workplace virtual or otherwise. It reduces their productivity and engagement and it reduces the productivity and engagement of those around them. So whether an employer enters this through a philosophical lens or through a business-led lens, it brings it to the same place. We have to step up with expanded dialogue, awareness programs and services around that and we think that’s a positive. It’s a positive that more people are embracing this proactively as opposed to reactively.
McGirt: It’s so interesting. When you when you’re talking about mental health, are you also talking about addiction, is that is that part of it?
Cordani: One-hundred percent. So when I think about it, you think about historically as a country, and globally, when we were talking about mental health, we typically talk about mental health and substance abuse and or addiction. Now extend that continuum stress, anxiety, depression, more complex behavior health, addiction, substance abuse, etc. It’s that broader continuum. In the early on, entree to it, the stress, anxiety and depression oftentimes leads to more abusive behaviors, substance abuse or otherwise.
Murray: And maybe that’s the answer to my next question, but what I was going to say was, you know, the first thing I hear from CEOs now around this issue is mental health and the effects of the pandemic and pandemic fatigue and all these things going on in the workplace. But the second thing is, health care just gets more and more expensive and they don’t want you to reduce the cost. Can you do both? You’re being asked to take over a larger part of these employees lives, but do it at a lower cost.
Cordani: So there’s no doubt health care is expensive. It’s increasingly one of the larger expense items on an employer’s income statement from that standpoint. So first, you need to be instructed by why is health care costs, what it is, why is it going up. Let’s talk about why it’s going up. The U.S. population is aging, the global population is aging. With that comes more…
Murray: Can you stop that?
McGirt: Asking for a friend.
Cordani: In some ways, you could you could modify the curve, right? So it comes down to quality as opposed to the chronology dimension. So we take the aging curve, then you take lifestyle. A lot of health care costs correlate to lifestyle, sedentary lifestyle, do you exercise or not food intake, balanced or not? Alcohol consumption, balanced or not? Smoking? Yes, no. Those are the four major lifestyle events that come into play. And then we have new innovations. We lead the world from an innovative standpoint in terms of device or especially pharmaceuticals from that standpoint. So those are pushing costs up.
What are the opportunities to reduce cost? How do you keep somebody healthy in the first place? How do you identify somebody who is healthy at risk and lower the risks? 25% of the population is healthy at risk. That’s 80 plus million Americans who you can identify with the right information. Are they going to have a coronary event down the road or are they high risk for certain cancers or are they in a pre-diabetic state? Or is the expecting mom likely to deliver prematurely?
Murray: So what do you tell CEOs who are worried about the mental health crisis and trying to figure out whether they’re doing enough to address it?
Cordani: In many cases over the last, let’s say the last decade, there have been a lot of innovations in the health and wellbeing space, including behavioral health, that the market knows as point solutions. So if you bear with me, employers will buy another solution, another solution, another solution, all with the noble objective of helping your company helping their co workers etc. And in many cases, what’s happening right now is employers and CEOs are sitting back and saying, there’s a mental health and behavioral challenge that I have. I’ve invested in and I have 10, 15, 20 disparate programs. Maybe I need to step back and look at it wholesale. Because what I’ve done is I’ve pushed too many fragmented alternative choices to my employees, and some are benefiting from but the whole definitely are not. So employers are stepping back almost in a redesign, a bit of a strategic redesign to the benefit programs, which we think is very constructive, because in many cases, the individual was left as the kind of general contractor having to pull these solutions together. And now there’s more coordination of those programs and services that companies like ours bring forward and employers are stepping back and revisiting what they’re offering.
The second part that I think is important is more and more CEOs are looking at these decisions like any other long term strategic investment they make, which is also very healthy, as opposed to an annual budgetary item on the expense base. Because at the end of the day, their company is fueled by their people, and their people’s health and well being or engagement and productivity are interrelated. So you see them making much more strategic decisions.
Murray: I’m here with Joe Ucuzoglu, CEO of Deloitte US, and had the good sense to sponsor this podcast. Joe, thanks for being with us. And thanks for your support.
Joe Ucuzoglu: Pleasure to be here.
Murray: So during the pandemic, we saw a real shift in how people view mental health and well being and how they incorporate it into their daily lives. People were under such stress, learning to work from home but also dealing with the challenges of caregiving and family life. Is this shift going to mean a reset in how we approach mental health and well-being overall?
Ucuzoglu: Alan, this has absolutely been one of the biggest themes coming out of the last couple of years. The impact of pandemic isolation, uncertainty, fear, on people’s mental health, and in some ways, it’s caused the topic to be much more openly discussed for people to come forward, get the help and the resources they need. And that’s a real sea change and one that we need to sustain.
Murray: So what’s your advice to leaders who are trying to figure out how to deal with that sea change?
Ucuzoglu: This is an area where companies can do so much good providing the necessary support, access for counseling, tools to help drive overall wellbeing, and increasingly, you’re going to see this become a bigger component of people deciding what type of organization they want to work at. And the tone has to be set at the top. Continuous reinforcement by leaders, acknowledging the challenges, reinforcing support for their people and supporting new work models that contribute to well-being.
Murray: Thank you, Joe.
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McGirt: Well, let me ask you about the human side of all of this. In an earlier iteration of my now lengthy career I was a pretty devoted health care reporter. And I spend a lot of time on that interface of new technologies and what it means for a health care provider and what it means for a patient. I think you know better than anybody else is that if you had a major surgery, and you talk to your doctor the next day and they told you to do this, this and this, you were likely to do it. You weren’t likely to do it if you got an email or a text or something, like the human piece of it. How are you thinking about technology changing the way that you can reach more people but still making sure that people feel connected to a human being that cares about them? Because that seems new to me.
Cordani: Yeah, I think your connected nature, that theme of connection, yeah, if you come back to the word vitality later. Let me give you an example. We launched this year, Pathwell bone and joint programs. In the United States about 50% of Americans have a bone, joint or musculoskeletal challenge. About 50%. So we’re there. The United States also leads the world in low back surgical interventions. There are other alternative paths for individuals to pursue. So by presenting the more complete information and helping an individual understand through their physician there are choices and alternatives, and then keeping the line communication open. We see more people choosing not to have surgery, but their choice, in consultation with their trusted provider, acting in physical therapy and other lifestyle adjustments. And having a more complete outcome from that standpoint. That’s an example of using information but it’s patient or customercentric. One person at a time with a medical professional presenting choices, pros and cons and alternatives. That’s more of the bright spots that are transpiring. But I agree with you, it’s the human connection, and it’s whoever a patient trusts, enabling them to have the best complete fact based information. And then lastly, having the reward or the payment program, reward based on quality of outcome not just volume of services consumed. When you close that circle, really positive things transpire for the patient or customer.
Murray: You used the word vitality just a minute ago, and I know Cigna recently launched a vitality index. What’s that all about?
Cordani: So as we talked earlier on, we’re guided by our mission and we stepped back and say, okay, where does this take us? Where does health and wellbeing take us and we concluded that vitality was the most comprehensive definition of an ability to thrive, an ability to excel, an ability for an individual to obviously be their best self at all given points of time.
Back to just like the loneliness work, we did resilience work. We wanted to make sure we understood it and had a way of measuring and guiding it. So we collaborated, developed a vitality index with a thought leader, were able to over almost a year, validate the datasets and draw some conclusions from it. Preliminary conclusions whereby individuals that have higher levels of vitality as measured through the index. Let’s go through the employer landscape tend to have higher productivity, higher engagement, higher job satisfaction, lower turnover from that standpoint. And by the way, back to the PowerPoint, they also tend to have a close working relationship with a physician. Right? They have a trusted partner, right? Those that have lower vitality measures tend to have lower levels of engagement at work, lower levels of productivity, higher probability of turning over and a lower percentage of them have a relationship with a physician—we call them primary care, OB-GYN, geriatrician, etc.—that they trust to be their navigator or portal to care from that standpoint.
And then from the vitality index, we carry that forward to use it as a tool. We can measure it at a community level, we can measure it at an employer level, and then design programs and solutions that could advance the level of vitality. Because vitality means helping individual perform at their respective highest level. What sits at the foundation of it is health. With your health, you could pursue vitality, spiritual vitality, community vitality, etc. Without your health that’s a fundamental foundational building block, almost Maslow’s hierarchy of food, water, shelter, health sits at the foundational level of that.
McGirt: I do have some leadership questions but I do have to make a Fortune quip here is that at some point, somebody in our newsroom is going to try to link the vitality index to revenue right? Like the most vital organizations are the most financially productive organization. That’s coming. You know that.
Cordani: I think that’s a great correlation to make. high engagement, hybrid productivity, low turnover passionate coworkers, make for successful corporations.
McGirt: And that leads me to my leadershipy question, which is really about the stakeholder world that we’re walking into. Because I think that’s really important. You’ve mentioned several times that your co-innovators, that your co-partners, and even in your acquisitions a long time coming, you had already partnered with people before you began to work and integrate your your paths together. What have you learned about creating partnerships that work?
Cordani: So interesting. I love your phraseology, leadershipy questions. We believe deeply and I personally believe deeply that leadership starts with great listening skills. So as an organization, we believe deeply and we state one of our strategic imperatives is we seek to be the undisputed partner of choice. We chose those words very carefully, because it’s a high order, seek always in pursuit of undisputed and then partner of choice. So then now to your question, whatever is worth working on, find mutuality, do the hard work to find mutual alignment. And the notion of partnering tells us if you’re going to try to do a business relationship with either another corporation, a health care provider group, a community organization, and it’s going to essentially be a contracted relationship in some way where someone’s trying to get 51% and someone 49%? Failed proposition out of the start. Conversely, instead of arguing over who rips the loaf of bread in half, how could we bake more loaves of bread? How could we envision something together that we bake more loaves of bread? And can you collaborate and if you and I are going to partner, is your contribution to me interesting? Is my contribution to you interesting? That’s table stakes. The third question is the hard one: is our contribution to society or an addressable market or community a step function. When all three of those work, then you have something to go to work on. And we’ve had successful collaborations or partnerships all over the world, both commercial as well as community-wise from that standpoint. It doesn’t mean we’re right, it means we’re in the relentless pursuit of working with other like-minded organizations to accelerate and pursue our mission, which is to improve lives.
Murray: I want to turn a little bit and talk about your health, your vitality. You’re a triathlete, I believe, you know, swim, bike run. Are you still doing that?
Cordani: So last year, I want to make sure I get the years right. 2021 was my 30th anniversary. So last summer I went back into the race I started back in 1991. So it was my 30th anniversary race. So I’ve raced for 30 years save one year when I had to have knee surgery. This year, I’m not racing, believe it or not, I’m dealing with a back injury.
Murray: Wow, sorry to hear that.
Cordani: So modified a little bit but a very active lifestyle. I work out every morning and maintain my fitness level.
Murray: How do you how do you find time to do that? I mean, Cigna is a big company. You have a big job with incredible demands on your time. How do you manage to make that work?
Cordani: Like all of us, all your listeners, life’s busy, there’s no doubt about it. And everybody’s juggling. It’s a matter of prioritization. So I find that I am more effective if I get a workout in every morning, no matter where I am, no matter where I am in the world. A month ago I was in Dubai with my colleagues visiting our Middle East operations, you know your timezone upside down, etc. Every morning, I was there for three mornings, I got my workout in the morning for an hour. So it’s a matter of discipline. And I find that the physical health is as important as the mental health. I get aligned around my day ahead. I’m able to digest the news in some way shape or form using you know, devices and otherwise, I’m able to get a good workout, get centered and be ready to take on the day ahead. And it’s a part of my life. It’s a part of the way I live.
Murray: You haven’t mentioned sleep, which is also part of vitality. Do you get a good night’s sleep in?
Cordani: Most of the time. Most of the time I do and sleep is quite important. So it’s back to trying to be disciplined relative to that. So breaking out you’re finding your own personal recipe. I work a lot because I love what I do. I feel very fortunate to do what I do. I’ve been with Cigna Corporation for over 31 years and I’ve been in the CEO seat for 13 years. And I remind myself how fortunate I am to help pursue our mission. So we have two children, active part of the children’s lives, the physical activity, try to get a reasonable amount of sleep and be disciplined relative to that, and then like everybody else, be human and understand how to adjust those dials all the time. Right. You have to be mindful of adjusting the dials up or down a little bit all the time.
McGirt: Can I ask the question about how you think about the future? I’m thinking back to, you’ve been at Cigna a long time. You mentioned CEO since 2009. I don’t know what you imagined the job was going to be what the future was going to be then. I don’t think that most people thought that climate change and the effects of climate change and how that was going to impact people’s health and well being was part of the remit it clearly is now. I don’t think people necessarily thought about race and violence and discrimination, how that’s going to be part of the health and wealth conversation, but it is now. So I’m curious how you think about the future? What are the big things that you need to be solving for now, 30 40 years down the line to make sure that you’re you’re continuing to go in the right direction and partnering and all the right ways.
Cordani: It’s a big question. I come at it a couple different ways. We’ve been quite fortunate. We’ve grown our company in excess of 10% for the last dozen years. And we’ve done that by managing the present and having an eye toward the future. And if I think now to the core of your question, some of the forces of change, you articulate, there’ll be new ones, there will be new ones 10 years from now that we’ll be talking about, but I think it’ll be a constant in the middle and that is the humans’ drive. The human dimensional drive for satisfaction, fulfillment and the ability to be a productive part of society and the environment around us and I don’t mean that in terms of climate, climate, the environment around us being safe and allowing a diverse group of individuals to learn, thrive and excel. As a global health service company when we started talking about our journey 13 years ago, health, well being and at that time, we talked about sense of security, those were not phrases that were used in our space. Investing in wellness programs at the rate and pace we’re investing in, in a services-based environment were not the way we were talking about them today. I’m not saying we were right and others were not. We had an eye toward helping to improve people’s lives. We had an eye toward helping to figure out how do you reward physicians for not providing services that should not be provided.
Back to the future, technology and data will provide fuel for step function, step function, massive change to what we do. But in the center, there will always be a person and there will always be a medical professional that needs to be connected in a highly personalized way. And lifestyle, quality of life and behavior will be a centerpiece in terms of someone’s overall health and well being. And our job is to help individuals thrive, corporations thrive, communities thrive from that standpoint, which brings us back to vitality.
Murray: You’ve been doing it for a long time. I mean, the average CEO tenure is about half of what you’ve already done.
Cordani: I am very fortunate to be part of Cigna where back in the 08 09 financial meltdown when companies were going through the reformatting, I had an opportunity and we’re a company that believes in that mission that we always come back to. What drives our colleagues around the globe is the opportunity to impact someone’s life for the better every day. And the mission we have of improving the health, well being and peace of mind of those we serve, and the partnering notion we talked about, and relentless change. But that relentless change comes back to one person at a time and acknowledgement that all health care is local. And that’s what fuels our innovation in some of the new services we talked about today that we’ve already brought forth in the marketplace are instructed by that.
Murray: Ellen should we let this man get back to saving lives and making people healthier?
McGirt: No. It practically runs itself at this point. [Laughter.] He can stay and answer questions.
Cordani: Ellen, I’ll tell people you suggested I take a year off.
McGirt: Just a couple more minutes. That’s all.
Murray: Thank you so much. Fascinating conversation.
Cordani: Good to be with both of you. Thank you so much.
McGirt: You’re a good sport.
Murray: Leadership Next is edited by Nicole Vergalla, written by me, Alan Murray, along with my amazing colleagues, Ellen McGirt and Megan Arnold. Our theme is by Jason Snell. Executive producer is Megan Arnold. Leadership Next is a production of Fortune Media. Leadership Next episodes are produced by Fortune‘s editorial team.
The views and opinions expressed by podcast speakers and guests are solely their own and do not reflect the opinions of Deloitte or its personnel. Nor does Deloitte advocate or endorse any individuals or entities featured on the episodes.