CIGNA CASE STUDY

Shift Towards Human-Centric Design

Interview conducted on August 23, 2018

Participant

Guy Suesuntisook
Senior consultant, innovation and strategy COE
Cigna

This case study explores design thinking initiatives and methodologies at Cigna, a worldwide health services
provider. Drawing from an interview with Guy Suesuntisook, senior consultant for innovation and strategy at
Cigna, the case study describes the impetus for design thinking at Cigna, the methods and models that the
organization has found to be effective, and key lessons from Cigna’s design thinking journey.

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 Cigna is a worldwide health services provider with headquarters in Bloomfield, Connecticut and
Philadelphia, Pennsylvania. The organization and its subsidiaries offer dental, medical, disability,
accident, and life insurance primarily to customers in the United States and select international
markets. Cigna has approximately 46,000 employees and reported revenue of $41.6 billion for
2017.

To remain competitive and keep a focus on the customer experience, Cigna is actively working
to integrate design thinking into the daily work of the organization. Design thinking is a human-
centered, iterative approach that seeks to understand the end-user of a tool or product, define
the challenges and goals of optimizing that tool or product, and brainstorming, prototyping, and
testing solutions as necessary. While the integration of design thinking at Cigna is ongoing, the
organization’s efforts thus far have allowed Cigna to focus more on the customer experience,
save money, and break down knowledge silos for more streamlined knowledge and process
management.

In August of 2018, APQC interviewed Guy Suesuntisook, senior consultant, innovation and
strategy COE at Cigna about Cigna’s design thinking initiatives. Suesuntisook shared insights
about the impetus for design thinking at Cigna, the frameworks for putting design thinking into
action, and the need for organizations to allow the time, space, and practice for design thinking
to flourish within an organization.

IMPETUS FOR DESIGN THINKING

The impetus for design thinking at Cigna came from two considerations.

1. Systemic Changes in the Industry. According to Suesuntisook, there was a realization

about widespread and systemic changes to the industry more broadly. “Not only the
systemic changes,” Suesuntisook clarified, “it’s the realization that healthcare in this
country is in a process of fundamental reevaluation and reformation.”
2. Drive for Improved Empathy. Cigna has always had a customer-centric culture and
began to increasingly see the benefits of design thinking for fostering more empathy for
customers.
Design thinking, which emphasizes human-centered methodologies and continual, iterative
approaches to problem solving, presented a way for the organization to adapt to change more
quickly and focus more intensively on the customer experience.

More broadly, the organization also needed to pay attention to megatrends in the healthcare
industry and beyond: “We have to look at other industries. We must look at other countries,
other populations, other places to find inspiration and stay grounded. We have to understand
what people’s needs are and know what problems to solve and go from there,” Suesuntisook
explained. Design thinking provides the tools and approaches for drawing inspiration from
outside an organization and beyond its industry, even as it fosters a more intensive focus on the
customer.

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 DESIGN THINKING TEAMS
The application of design thinking methodologies at Cigna is currently “somewhat
decentralized” at the organization, particularly as Cigna continues merger discussions with
another organization. For now, Suesuntisook said, Cigna is “speaking in broad brushstrokes,
looking at all the different parts of the company that are about innovation and asking how we
can better align those things for a more coordinated approach.” At the same time,
multifunctional Agile teams are laying the groundwork for communities of practice by
developing human-centered methods and tools that can be utilized across the organization in a
flexible way. As the communities of practice begin to develop and grow, an important goal of
the organization’s efforts is to encourage team members to share knowledge, mentor each
other, and learn from each other.

Cigna’s Agile teams also carry out design projects based on continual evaluation and
reevaluation of the customer experience. Once a year the organization evaluates the customer
journey to find opportunities for design-based projects. “We’ll look at the entirety of that
journey and prioritize specific key areas,” Suesuntisook noted. “We form a project team around
each of those key areas and develop multidisciplinary Agile teams across them. The idea is to
bake design thinking and human-centered methods into the framing of the problem, so those
tools will be integrated throughout the life of the project.” Projects can range in length from 3-6
months on the low end to 18 or 24 months at their longest.

TRAINING AND ENGAGEMENT FOR DESIGN THINKING

Cigna plans on building a program to introduce employees to the basics of design thinking and
form communities of practice. Design thinking, Suesuntisook said, is something that should be
spread throughout the organization rather than left within domain of a group or team. “Design
thinking is not something that ‘belongs’ to a certain group or cadre of people. It’s something we
want to be accessible and available to the entire workforce no matter what their role is,” he
noted. Design thinking fosters people-centered approaches, enhances the ability to navigate
complexity, and promotes an open mindset—traits that Suesuntisook said are good for anyone
working for the organization.

While Cigna aims to make training widely available, the organization is also working on a high-
potential, development program to identify employees who demonstrate talent and initiative in
design thinking. High potential employees can be nominated by leaders, workgroups, and
managers for advanced training and application of design thinking. The broader goal of these
efforts is a community of practice that includes experienced employees with leadership
potential, who help train and mentor others. “Over time, those who go through the leadership
program can come to be the people who the newer groups talk to, get counsel from, and get
training from,” Suesuntisook explained. Leadership development programs have long been an
effective part of Cigna’s culture as an organization, and the organization plans to make use of
this model for training in design thinking as well.

PUTTING IT INTO ACTION

To put design thinking into action, Cigna utilizes and draws inspiration from the double-diamond
model of design thinking as well as the Innovation Ambition Matrix (IAM). These frameworks

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 allow the organization to work strategically through the design process while keeping the
customer experience at the center. The frameworks also provide strategies for assessing and
prioritizing solutions to design problems across the organization. While design problems and
solutions can be customer-facing, related to product development, or aimed at impacting
existing partnerships, the double-diamond and IAM have both proven helpful for design thinking
at the organization.

DESIGN THINKING PROCESS: THE DOUBLE DIAMOND

Cigna’s design thinking process follows a version of the double diamond model of design
thinking, pictured in figure 1.

Double Diamond Model of Design Thinking

Figure 1

The double diamond is a design process includes five main steps for human-centered design:

1. Empathize—understand the customer and their needs.

2. Define—scope the problem from the customer perspective.
3. Ideate—brainstorm potential solutions.
4. Prototype—develop minimally feasible models of potential solutions.
5. Test—conduct a series of assessments on the applicability of the prototypes.
The double-diamond process is an iterative process, meaning that there is not always a linear
progression from one step to the next. The design process might move in a more cyclical or non-
linear way. The steps “can come back around on one another depending on where the project is
and how things are going,” both at Cigna and beyond. Movement through the process includes

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 phases of divergence, where several ideas are circulating for consideration, and convergence as
the team narrows down ideas, prioritizes them, and begins to work toward a solution.

Cigna realized it needed to adapt the model to its culture. Hence, Cigna added its own
customizations and modifications to the double-diamond model. For example, Cigna’s double
diamond includes steps like “assess and plan,” and additional sub-steps that are Cigna-specific.
“On the tail end of the process after prototype and test, we add things like prioritize and plan.
It’s one thing to rapidly create solutions that solve a human need, but we need to think about
how we’re actually going to make this happen,” Suesuntisook explained.

APPLICATIONS OF DESIGN THINKING

To prioritize design projects and explore areas for further application, Cigna also uses the
Innovation Ambition Matrix1, shown in figure 2 below. The matrix includes three concentric
circles: the core, the adjacent, and the transformational. Collectively, the three circles represent
existing opportunities for innovation at varying levels, moving from an organization’s day-to-day
work and existing customers to new partnerships and ultimately to products or services that
currently do not currently exist.

Innovation Ambition Matrix

Figure 2

1. Core innovation initiatives focus on making incremental changes to optimize existing

services and products for existing customers. Examples of core innovation initiatives

1
“A Simple Tool You Need to Manage Innovation” Harvard Business Review, Retrieved September 7, 2018.

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 include replacing packaging, reformulating an existing product, or any other innovation
that draws from assets that an organization already has in place.
2. Adjacent innovations, meanwhile, are aimed at leveraging an organization’s existing
resources into new projects and partnerships.
3. Transformational initiatives that are designed to create products and services that do
not currently exist.

The x axis of the matrix is labeled “how to win,” and encourages incremental additions that
build on a foundation of existing products and services. The y-axis, meanwhile, prompts thinking
about “where to play,” or where to put resources toward innovation. Taken as a whole, the
matrix encourages organizations to think broadly and comprehensively about innovation. The
matrix makes no prescription about which circle to prioritize but facilitates deeper thinking
about innovation at varying levels of scope.
Cigna has teams deployed across all three circles of the matrix from the core to the
transformational. Innovation work at the core, Suesuntisook said, includes things like optimizing
processes in sales. “Those are the simpler things that could be operational in nature but could
basically mean the difference between winning or losing a sale,” he noted. Work in the adjacent
circle includes extending reach and alignment with partners like emergency rooms to streamline
care, lower costs, and help emergency room patients tap into their benefits more quickly. For
the transformational circle, Suesuntisook noted, development of blockchain tools is one idea the
organization hopes to develop.

Deploying teams across all three circles at the same time demonstrates Cigna’s recognition that
design problems and solutions are part of an ecosystem that includes multiple audiences and
people. “It all begins with the customer and the need we’re solving for them. At the same time,
there’s an ecosystem of different people it affects. If we’re tweaking something on the customer
side, we need to look at what that means for the tools and systems that support our caregivers
or even our intake process,” Suesuntisook explained.

BUSINESS RESULTS
The use of frameworks like the double-diamond and IAM for design thinking across the
organization has led to positive results at the core, adjacent, and transformational levels of
innovation.

First, optimizing its existing processes and services has saved the organization time and money.
“I can get something in front of a deployment team in two days that used to take two weeks,”
Suesuntisook said. The organization has also made changes to streamline collaboration,
resulting in meetings and project check-ins that are more efficient and effective. Suesuntisook
noted that process optimization has lowered Cigna’s costs and allowed it to be nimbler in the
market overall.

Cigna has also seen positive results in the adjacent circle as it continues to consider how to
expand its reach and meet the needs of new customers. For example, the organization noticed
that its competitors and other organizations outside of the healthcare industry were providing
retail locations to better connect with customers. To explore whether a retail space would be

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 helpful for Cigna’s customers, the organization invested $10,000 in creating a cardboard
prototype. “We built a prototype retail space out of cardboard and duct tape, and had people
come through over the course of the week and asked them, ‘Hey, if we built this would you
come?’ In that case, $10,000 probably saved us a couple of million dollars because we realized
that there are a lot of great things we could do, but it doesn’t mean that people necessarily
want a retail space,” Suesuntisook said. Cigna’s use of the double-diamond model, which
includes an emphasis on prototyping and testing, has resulted in significant savings and helped
the organization avoid costly investments that may not pay off in terms of the customer
experience.

The transformational sphere of innovation is another area where design thinking frameworks
and approaches have helped Cigna to work more strategically. Thinking about transformational
innovation, for Suesuntisook, includes “how we think about the next generation, the people
who aren’t even born yet, and look at the next generation of offerings. Design thinking for
transformational innovation has allowed the organization to generate concepts for a future
vision that it can continue to work toward. “That gives us the confidence to continue to build
things that we can prototype. We’re not just making a guess and heading in a certain direction.
We have a vision that we’re working toward. We know we have the ability to scale in the future
to be where we want to be,” Suesuntisook noted.

KEY TAKEAWAYS AND LESSONS LEARNED

For Suesuntisook, one key takeaway from Cigna’s design thinking initiatives is the importance of
change management to engrain design thinking a part of everyday work. Design thinking,
Suesuntisook said, “is not something you want to just sneak into. It’s something you want to
bake into your culture.” A common pitfall for organizations is to treat design thinking as a one-
off experience that stands apart from daily work. “It shouldn’t be something that you do one
time and then never do again or go back to the way you’ve always done it,” Suesuntisook
cautioned. Change management through high potential development programs, mentoring, and
training is key for integrating design thinking into daily work and projects.

Integrating design thinking into daily work also means prioritizing the most important problems
and solutions rather than focusing on “shiny objects”: solutions that are attractive and
compelling but do not serve a direct need. “We don’t want to create solutions in search of a
problem,” Suesuntisook noted. “We want to keep people in mind: will this thing help them?” A
well-executed design thinking program keeps employees on point and focused on the human
component of healthcare, which results in solutions that are relevant and effective for
customers.

Another important lesson from Cigna’s journey is the need for patience when it comes to design
thinking. Much like a musician learning to play an instrument, Suesuntisook said, it takes time
for employees to learn design thinking and put it into practice in effective ways. “You can’t send
a team of your best and brightest for a jam session with seasoned jazz professionals and expect
them to make hit songs the next day,” he noted. Employees need time and space to practice and
work with mentors who will push them toward continuous improvement. If they are given a safe

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 space to practice and make mistakes, employees can grow their design thinking skills and “solve
for things that we haven’t even imagined yet,” Suesuntisook said.

Creating a safe space for learning and experimentation around design thinking requires buy-in
from key organizational stakeholders, especially executives. One effective strategy for doing so,
Suesuntisook noted, is to approach them with customer stories rather than focusing exclusively
on facts and figures from the industry. “We go straight to our leaders and say ‘hey, I’m going to
play you a clip of one of our customers talking about the challenges they have around
understanding their premium. This is raw. This is real. This is a person who is struggling and has
a need.” While many executives are used to breaking down a problem in terms of facts and
figures, Suesuntisook advocates a ‘yes/and’ approach that pairs quantitative data with
anecdotes and other qualitative data to highlight the customer experience. “The reality is that
we live in a world where health insurance is a commodity. Tying that human component to facts
and figures is a way that we can differentiate ourselves.”

Qualitative data, including stories of the customer experience, can be an

effective resource for communicating with key stakeholders about the value
of design thinking.

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