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Hello, everyone.
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Welcome to Future Ready Leadership.
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My guest today is Adam Kotzner, President of EverNorth Care Management and Express Scripts and EVP of Customer Personalization for the Cigna Group.
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Adam, thank you for joining me.
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Thanks for having me, Jacob.
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Appreciate the time.
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Yeah, I'm looking forward to the conversation.
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Today, for those of you who are tuning in, we're gonna be talking about navigating through the critical middle of a major year, multi-transformation.
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So lots of organizations are going, whether it's AI transformation, whether it's acquisitions or mergers or regulatory, every company these days is going through some sort of major transformation.
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So Adam's gonna unpack
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how to make those things successful and what he's learned through some of the big transformations he's been involved in.
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So, Adam, maybe high level, why don't we just start with background information about you and the company in case people are not familiar with it?
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And then introduce the transformation that you guys are going through.
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Sure.
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Yes.
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Happy to do that.
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So I'm part of the Cigna Group.
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Cigna Group has...
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three major businesses within the healthcare space, one being Cigna Healthcare, the other being our pharmacy benefit services business within the Evernorth Health Services, which I lead, and then we have a specialty and care division as well.
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Our goal is to improve the health and well-being of patients across America.
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We serve well over 100 million Americans in many different ways to meet their health care needs.
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My specific role in leading our pharmacy benefit services where we do serve over 100 million Americans, predominantly employers, health plans and labor unions.
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And our goal is to
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improve the access and affordability of medications for patients.
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And I'm a pharmacist by training.
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I have been in the industry for over 25 years, been in Express Scripts for about 18 years now and enroll over three years in leading this organization.
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And throughout my time in health care, we have continued to focus on innovation and change.
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The speed at which we continue to develop new drug therapies has become lightning fast.
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And it's going to continue now with AI as manufacturers continue to develop new solutions and new products.
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And that's exciting.
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But it also comes at a time where we have to balance the access and affordability components and ensure patients are getting the drugs that they need most.
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And that's exciting.
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those that are going to have the best effect for them.
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And our focus right now within the pharmacy benefit services area is, yes, working towards transforming our business into something that's brand new, which I'm sure we're going to get to talk about today.
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But I have the opportunity here to have a 360 degree view on the perspective of a meeting directly with our patients, but also our clients that we serve as employers,
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And then ultimately how we're able to enact across the drug supply chain to ensure that from a healthcare perspective, we continue to navigate those things and balance the access and affordability components.
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And how many employees do you guys have?
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So our organization in total has over 60,000 employees.
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employees within our pharmacy benefits business.
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We have several 1000 employees plus all of our operational colleagues that are there to help patients and providers be able to access the healthcare they need.
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Okay, so massive, massive organization.
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So why don't we unpack a little bit some of the transformation that you have been going through.
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So I can't remember how long how long have you been at the company?
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Over 18 years.
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18.
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Oh my goodness.
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It's a long time.
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So what are you guys actually going through as far as transformation right now?
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So the pharmacy benefits business in total is going through quite a bit of transformation across our industry.
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We spent the last couple of decades in a business model that was working well to serve
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our clients and also to serve patients.
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But we realized a couple of years ago that we needed to continue to drive
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a better predictability for our clients and ultimately for patients, improving that affordability and access and being able to ensure that we were able to simplify the pharmacy benefits.
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They've become much more complex over the years and over the decades.
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And so we took it upon ourselves a couple of years ago to think differently, to start
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at the very beginning and re-engineer with the patient as the center of what we're working to try to solve and then working back from there across the entire industry.
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And so that's led to our new signature pharmacy benefit services that we launched back in October, which essentially,
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completely changes the pharmacy benefit model, putting the patient first, delivering new, predictable economics for them so they can access those drugs they need.
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And it will set us up for a much better future, both from a patient perspective, but also for employers as we work towards the future.
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So can we go a little bit deeper into that?
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So what was it like before versus what is the kind of new version like?
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So if I was a patient and I wanted to get a prescription or something like that, can you kind of explain the before and after?
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Sure.
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So today, when you go to the pharmacy counter, in many cases, especially if you're taking a branded drug that may be high cost, you may not know what the cost of that drug is going to be.
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And in many cases, if you have a deductible or a high cost,
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percentage that you pay, a coinsurance that you're going to pay, you're not sure how high that's going to be and where you are within that deductible phase.
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And those drugs can be really expensive.
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Now, what's negotiated on the backside of that are, in many cases, discounts or rebates that are provided back to plan sponsors or to employers.
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And
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in this new model, those discounts, although today in many cases, those aren't passed back directly to the patient, we're contracting in a new rebate-free model that's going to deliver better predictability.
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So Jacob, you would know, your family would know before you go to the pharmacy counter how much that drug's going to cost.
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We're going to negotiate a discount upfront on your behalf with that drug manufacturer.
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A discount's going to be passed through directly to you at the pharmacy counter.
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It's simplifying the benefit.
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It's improving that access.
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And then from an affordability perspective, on average, for patients in that type of situation, it's going to reduce their costs by 30% or more.
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Okay, so it sounds like before this was all kind of done in a black box.
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You kind of show up to the pharmacy.
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They tell you what you need to pay.
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And then you really don't have any insight on that.
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You kind of just hand your credit card, take whatever you need and go back.
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And so now it sounds like you're opening up the black box and you're explaining the pricing, how it's structured, discounts.
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Everybody has a lot more visibility into basically what's going on behind the scenes.
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Yes, and I would take that even a step further as well.
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So today, you only know what that cost is at that pharmacy that you're going to and whether that's in your pharmacy benefit or you might be pursuing what's the cash price for that drug on a different basis.
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platform, or maybe I can go to a direct to the manufacturer and get a different price from a pharmacy that they're running.
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We're going to bring all of those pieces together.
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So through our, what's called our new price assure functionality, our system's going to go out and find the lowest price, regardless of where it exists in the market.
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Normally that is through your benefit, but sometimes it's not, we're going to find that lowest price.
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Then we're going to keep it within the benefit.
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So you get that lowest price, you get the transparency of a discount now that's applied.
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and you have the, essentially the peace of mind that you're going to get that product, you're gonna get the services, you're gonna get the safety and benefit checks that we do in every prescription, but you're going to get it at the very lowest price that it can be across all the different platforms and we're gonna simplify all of those pieces.
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So yes, it takes us a major step forward from where we are today.
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of you're not sure what the price is, you're not sure if you got the best deal and if that was the best place to get the product at.
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We're taking all of that out of the system so that you can rest assured for you and your family that you're gonna have the best access and affordability to these products.
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Can you unpack like what what does that transformation look like?
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Because for a lot of people, you know, on the surface is kind of like, OK, well, that should be simple, right?
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You just kind of collect a couple of different data points.
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You share those data points with the customer.
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You create a little dashboard with UI and you should be able to do that.
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And I don't know, like a month, two months.
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A lot of people don't understand the behind the scenes of that.
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I remember we had like the CTO of Uber on this podcast a while ago.
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And I was asking the same question.
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I said, well, you know, a lot of people, they just open up the app, they push a button and a car shows up.
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You know, what's so complicated about that?
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And he was talking about the millions of transactions that are happening on a daily basis behind the scenes, the algorithms that are required to route somebody from here to there, how they find somebody, the matching.
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There's just so much stuff that happens behind the scenes that people had no idea was taking place.
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So for you, when you're talking about this transformation where you're basically giving customers more data, more insight into things that they're buying,
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How complicated of a transformation is that?
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And then can you talk about maybe what was required?
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We can go on a people side, on a tech side.
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Like why was this never there before?
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Yes.
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So I, our business no different than, than Ubers and others can, can be extremely complex.
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We'll process over 2 billion prescriptions this year on every one of those prescriptions we do.
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over 18,000 safety quality and benefit checks.
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And every prescription that's processed is gonna go through tens of millions of lines of code to ensure that all those checks and safety can- For one prescription?
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For one prescription, yes.
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So when you start to unpack everything that has to change within our system of how we're going to be interacting with the patient to make sure they have the right information
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how we now will be interacting differently with drug manufacturers.
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And essentially, instead of contracting
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rebates that are paid retrospectively on the back end and they're estimated now, you're gonna get that discount upfront.
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So that completely changes how we have to contract with drug manufacturers and how we're able to apply those discounts so patients can realize that upfront instead of them paying months behind the scenes later on to clients.
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And that also changes the economics at the pharmacy level too.
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So for pharmacies that are dispensing those drugs, it changes those components
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and how they're gonna be compensated, when they're going to be compensated, and how they need to be able to push through those discounts as well from a patient perspective.
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So across the ecosystem, major changes have to occur.
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And what that means behind the scenes is yes, we're gonna be leveraging technology and an artificial intelligence in many cases to be able to build these new components much faster.
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But if you step back from those pieces, the first thing, as I mentioned, of starting with the patient and ensuring that the patients are going to be able to get what they need, when they need it, how they would like to receive it.
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So us engaging with them in a new and more meaningful way and ultimately providing a better overall experience.
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So you walk away.
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It's a much easier interaction.
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You can get what you need and move on with your day.
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And all of us today are dealing with the hyper speed of life.
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We wanna make sure from a prescription benefit perspective, that's also here and able to happen.
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And so starting with the patient, then stepping back and how we engage with drug manufacturers and certainly with pharmacies.
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And then ultimately with our clients, because our clients buy these services from us.
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We have thousands of clients, mainly employers.
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And so how they will interact with us
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buy these services from us, those components have to step back and change as well.
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So the full transformation as we looked across and understood the unpredictability that may exist today and how those things need to change, especially with high cost branded drugs continuing to escalate, that affordability gap continues to be a larger challenge, even though
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the demand for prescription services continues to increase.
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It's the most utilized benefit within healthcare.
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And so we needed to step in and provide a better way.
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And that's where the hard leadership decisions come in, right, of understanding that not just fixing what's broken, but also recognizing when a full model change needs to occur and having the perspective to take that head on and us to step through it.
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Why is it so many lines of code for one prescription?
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I think you said like 10 million or millions of lines of code.
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Is it like, is it because, I mean, like if I go and I get a prescription, I mean, I don't know what happens to it behind the scenes.
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It's kind of like when you check in luggage for a plane, it gets, you know, you drop it off at the kiosk and then you don't know the tunnels that it has to go through in the airport before it gets to the plane.
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So in this case for prescriptions, what is happening behind the scenes?
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Why is it so much code that's required?
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So those 18,000 safety quality and benefit checks that we do on every prescription, that's what much of that code is occurring to make sure that we're running all the different side effects to make sure that that drug is safe for you.
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And we're flagging any issues that might have to occur.
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We're running your prescription history that we have on you to make sure
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that there aren't any drug interactions that might have to be flagged or adjustments made.
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And then ultimately, for your own pharmacy benefit, that's how much it's gonna cost and where you are in your deductible phase and those types of components as well.
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So a lot goes into every prescription and in each transaction behind the scenes.
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So how does AI play a role in that?
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I mean, I would imagine, for example, let's say I go get a new prescription for something and I'm already on, I don't know, let's say three or four different drugs.
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I don't know, blood thinner, something for cholesterol, something for who knows what.
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And let's say I get a new drug that's prescribed for, I don't know, sleep or anxiety or something like that.
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Is AI kind of checking everything behind the scenes and looking at the site?
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Like, is that where AI gets used as one potential example to kind of verify and cross check side effects and things like that?
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So today, in most cases, no.
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In most cases today, all of those pieces are still hard coded into the system.
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Future state.
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AI will become a much greater part of what's leveraged across healthcare.
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In total as, but the integrity of how AI is going to be used,
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the accuracy of AI within healthcare has to be much better than what humans can do today before those components are going to be leveraged.
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Where we're using AI today and where we see it future state certainly is, yes, the speed at which we'll be able to interact and develop and put change in to improve the flexibility within the healthcare systems and the speed at which we're able to administer those pieces
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the consistency, and then ultimately the quality.
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But AI still has a long way to go, although we're seeing massive improvements as each month goes by.
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But ultimately, we'd like to get to a point where each patient may have their own AI agent.
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and their ability for that agent from a healthcare perspective to help them navigate through the system.
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It's a curated process then from a patient perspective so that patient isn't caught in the middle.
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And they can navigate that change and be able to have a much better overall experience where AI can be able to interact.
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So that overall member or patient experience is where I think AI will really be able to shine.
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And the behind the scenes, yes, from an operational perspective,
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just the speed at which we'll be able to work and improve the overall quality of our systems is also gonna be a very helpful place for AI to eliminate those, in some cases, tens of millions of lines of code on each prescription and be able to simplify those components in a new way.
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Well, it's funny, I hooked up my chat GPT account, my health account, right?
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They have, I think it's OpenAI Health or ChatGPT Health, where basically it looks at all your medical records that you have through whatever your healthcare provider is,
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And you can ask it questions and it'll analyze everything for you and answer those types of questions for you, which is fascinating because even for me, you know, if I want to, if I have a question for a doctor, he'll say, I need to go talk to this person.
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That person will say, I need to go talk to this person, make an appointment here.
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And to get basic answers or get a comprehensive view of your health could take, I don't know, several weeks before you even get somebody on the phone.
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Uh, and then you don't even know if they reviewed everything.
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Like there've been several times I go to the doctor and they ask me questions and I'm like, did you review any, like I got sent over here.
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Did you review anything over there?
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Uh, so with AI though, it's fascinating that it just, it, it has all the scans, all the blood work.
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It can tell me what vitamins I need, what supplements and why the pros, the cons.
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Uh, and it's, it's, I mean, it's amazing.
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You know, it looked at all the things that I was taking.
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It said, OK, remove this, add this.
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This does the same as this.
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And so the insights you can get from these tools, I think, is just fascinating.
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I agree.
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And I think.
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Yes, it will become second nature for many of us in the future of it already is starting to be.
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a component of your daily life and how you're utilizing it.
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I do think within healthcare though, there are still aspects where the accuracy of that information still has to improve and it will continue to learn as we continue to put more technology components into it.
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And that's where we'll be able to improve the personalization of those components, but ensuring that you are getting the most accurate information today, we may inherently in some cases,
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trust AI, but we've all had the experiences where it gives you back something that doesn't make sense.
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And that's within the healthcare space, that could be a dangerous component that we have to ensure doesn't happen and why we'll have to take more pragmatic steps than being able to put that out really, really quickly.
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Yeah, I've certainly had situations where AI will give me some information or insight.
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I'm like, what are you talking?
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There's no way that this is correct.
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And then you verify it.
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And of course, it's wrong or it hallucinated or whatnot.
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I'm curious on the transformation side, maybe we can dive a little bit deeper.
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How long of a process?
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How much does it cost?
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How did you get people on board?
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What were the details of the transformation and getting from point A to point B?
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So I love innovation.
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I love the transformation changes and those journeys that you're able to get on from a business perspective and the benefits that it can drive.
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But it's hard work and in some cases can take a long time.
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First, recognizing that that change has to occur and that a bold step is going to be needed, figuring out what that bold step is, right?
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That spark of the innovation and change that you need to be able to transform that creates quite a bit of excitement around what can be possible for a very bright future and setting that bold vision of where you're particularly going.
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But once that's done, you can think of that as the,
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the big press release, whether that's internally within a business or it's externally to the world of where you're going, then that hard work sets in.
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And that's what I would call the critical middle of
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So the excitement is there, but now the realization of the work has to get done, the complexity of everything that needs to happen, and the sheer force of an organization now has to move in a direction it may not want to move in, or it wasn't built to move in.
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And so that change is gonna be hard, and there's a lot to work through.
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And so staying with it, motivating leaders to be able to step forward into those spaces and create opportunities to be able to,
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learn fast, be able to fail fast where you have to, but continue to move forward each and every day to be able to stay on those timelines.
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And that can be an overwhelming time.
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But ensuring that there is appropriate leader accountability during that time, there are appropriate motivations that are there, and that you're creating trust within a core team that can work through those pieces.
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That's going to define whether you're successful or not.
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And leaders can't
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can't ignore that hard work in the critical middle after something's built up.
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You can't walk away from it.
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You've gotta stay in it and be able to ensure that you have
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the right teams in place with the right focus and expertise to be able to deliver on what ultimately is the outcome that you are looking to be able to deliver on.
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And that's a time too of, often we start with one place in a journey, we think we're going to a place and you lose your way, but staying on the right path to ensure that you're delivering on
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what the ultimate goal on is really really important as you step through that type of transformation and we are in the midst of one of those right now as we talked about the pharmacy benefit space where we are from an announcement last october to today but the work started a year before all of those things of what could be possible and so
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taking an organization on a journey like this, it has a little bit of a leap of faith of the work that has to get done in, in the future.
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But if you have that destination state in mind and,
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You know that the status quo is unacceptable going forward and change must occur.
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It creates that resilience within an organization to be able to deliver on something that in a lot of cases people thought may not have been possible, but you make it possible.
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And that's really, really rewarding from a career perspective, not only for the leaders, but also for those that are able to be a part of it going forward.
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So you said you started this around a year ago, is that correct?
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We started developing and having conversations on it a year and a half ago.
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We made an announcement this past October.
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So we've been in this for quite some time of realizing first change needs to occur,
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Many times, often when you've identified problems, you look at incremental change as the first answer.
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It's always the, potentially the easiest answer of what could I tweak, what could I adjust.
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But in this instance, and I think in many instances across all industries, you come to a point of, transformation really is needed.
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You have to think about this in a brand new way.
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And although it can be scary, it also can be
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be really rewarding.
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And as long as you have that right destination, it's one that an organization can pick up and be successful with.
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And how much longer do you have in this process, do you think?
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For our particular transformation within the benefits space, we'll be bringing some of our components from our Cigna Healthcare within the
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next year and then the rest of the market could go live as early as as 1-1-28 so start to finish it's it's going to be a few years before we we see it fully in in practice and then we'll have more and more of our clients be adopting it from 2028 and beyond so a lot of education is occurring right now on this transformation in the industry and how we're going to be doing things differently
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But that's such a crazy long time to go through.
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I mean, three, four years in today's fast moving world seems like an eternity.
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So how do you like if somebody were to tell me, hey, Jacob, you know, you're you're unhealthy and you can get healthy, but it's going to take you four years to do it.
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I'd be like, oh, my God, four years.
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You know, it's it takes too long.
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You know, people are so used to faster goals, instant gratification.
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So to tell a team of 60,000 employees, hey, we're going to be working on this project, it's going to take probably four years, if not longer, to get from point A to point B. Yeah.
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I mean, how do you get the momentum, the excitement, like kind of keep it there?
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It just, you know, you might not even have the same workforce at that time because people might retire or quit or get hired.
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So how do you manage such a long, you know, almost half a decade transformation for an organization that's so large?
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That's a great question.
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In the beginning, much of that is the
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innovation side, the time of smaller teams and groups working on what that future could be, right?
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So that's- It's the fun stuff.
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A year of that time off, but then you start the, yes, the actual hard work of motivating an organization and yes, pulling it forward.
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And yes, regardless of what level in the organization people are at, they need to be excited about the change.
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In healthcare,
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We have a bit of a bonus, I would say, of the higher calling of helping people.
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And this is a way for us to be able to do that.
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So having that patient in mind of what really has to change in order to develop a much better experience and health outcome for a consumer is motivating for so many of my colleagues and leaders and our ability to be able to change.
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having the right motivators in place for an organization is critically important and one that you can't skip over.
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Yes, there might be something that's right for the consumer, your clients and your business, but ultimately you have to be doing it for the right reasons.
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And that's the part that is going to be durable and have the resilience as you move through.
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And then certainly there are other components of ensuring that we have
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milestones that can push you through that critical middle, and that you're developing new components of what your destination was going to be, or the program was going to be, in different time periods throughout that journey, which means you're gonna realize a lot of things along the way that you hadn't figured out, or you need to figure out, and those become other small,
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micro innovation components within the overall journey of the pieces.
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And that also can be very motivating to our teams and to our leaders.
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And we create much more of a family atmosphere as well of we're in this together, we're going to build this together and be able to deliver something that is meaningful.
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And as you said, many people may be leaving an organization, they may retire,
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A transformation like this is from a career perspective, we do it right.
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It may outlive many of us in terms of our time within the healthcare space as professionals.
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And that's rewarding too.
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From a legacy perspective of changing whatever business you're in, for us it's healthcare,
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And that's going to have a durable effect that's going to be good for your family and your children, potentially for years to come until another transformation is needed after that.
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Yeah, it's funny.
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So I have two younger kids, a six year old and a soon to be 10 year old.
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My 10 year old daughter plays competitive chess and soon to start tennis.
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And my son is really interested in all things like robotics and technology.
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And so we're constantly having these conversations about how the things they're doing now are going to kind of shape who they are later.
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So, for example, my son right now, he does these little robots called VEX IQ.
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And so he says he wants to be a roboticist, an engineer, and he wants to build these really crazy things.
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But right now he's just building these kind of basic Lego techniques and plugging things in and messing around with little wires.
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And so for him, making the connection between something little that I'm doing now, playing with toys versus working in a...
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I don't know, robotics factory is a, it's like a, such a long-term stretch.
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And even same thing for my daughter, who's a chess player.
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Um, you know, she's turning 10 and sometimes she'll have a bad tournament or a bad game.
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And I'm trying to get her to think long-term, right?
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Imagine where you're going to be when you're 12, when you're 13, when you're 15, and,
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And so sometimes I think for people, it's very hard to imagine the future state, especially if it's several years away.
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Are you finding that you're constantly having to reinforce that future state for your workforce?
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You know, like the day to day, right?
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I mean, you have people who are showing up every day, they're coding, they have to be on the phone, building relationships, negotiating new things, probably for this kind of future state that you're building.
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Yeah.
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How do you constantly keep the narrative, the story of like, here's what we're getting to in a couple of years, right?
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Imagine this, imagine that.
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Cause you need a lot of that.
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Otherwise people just, it just turns into kind of a new day to day, it's just my new job, new work.
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Yes, it's not an easy task, but, and you're right, we are today doing things in a,
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the old way with some incremental improvements before you move to the full transformation.
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So you're having to do multiple things at once, which means people are having to work harder, deliver more, and it takes even more dedication to be able to get all of that done.
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But if I go back to creating the right atmosphere and building things together,
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and our ability to incrementally continue to improve those pieces and working in collective teams, those aspects can be highly motivated, motivating.
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We also create
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micro destinations within these different timelines to ensure that you're still getting to some type of achievement or milestone.
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It can't be just the achievement that's going to happen in two or three years to be able to
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reward employees in different ways and be able to celebrate the successes and getting over some of the most challenging things that you might face in a very long and complicated type of transformation like this.
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I also think it gets easier.
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If I think about even your son and robots, or you think about AI and where we are today and where we'll be in the future, the compounding effect of doing some
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hard things together, it gets easier to do more hard things together and bigger things that are even more difficult to do because you do have that compounded effect.
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No different than in technology and AI of a compounded technology component of it's going to get easier as you do more and more of those complex things and you get that muscle memory and that becomes even
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more fun of doing those and meeting those challenges together, which creates much more momentum to be able to sustain something that takes a long time to do from a race perspective in many cases.
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So there are a lot of different aspects I think you have to look at this from of what motivates individuals, what motivates teams, what motivates different leaders to be able to deliver on a complex,
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transformational type of change that many organizations have to go through periodically.
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Yeah, I like that mentality.
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I mean, I frequently tell my kids, do the hard stuff first.
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And then the more, if you can get used to the hard stuff, you like the process, then yeah, over time it does become easier as opposed to just kind of throwing something difficult at somebody one time and expecting them to solve it.
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So yeah, I mean, I can see how that makes sense, where if it's kind of a longer term transformation, you get more acclimated, you get more used to it, and it becomes a little bit easier for that process.
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Yeah.
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Um, have you had any stumbling blocks in the transformation process so far?
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Like pushback from leaders, employees who lose direction or vision, or has it just been smooth sailing for you guys?
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Oh yeah, completely not smooth sailing.
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You're always going to have a lot of different, you know, when we, when we made our announcement there, there, there was skepticism from competitors of how you're going to do this from, um,
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even some clients of how would this work?
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I've been doing it the same way for 20 years, 30 years.
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And now all of a sudden you think you can change this.
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And so, yeah, there has been a lot of education that it's taken even internally.
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Yes, you're right.
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Of employees have spent their entire careers doing it one way and now,
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that we said, well, there's a better way.
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And here's the better way.
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And good news, you're gonna get to help build this new way that we're going to be able to change an entire industry on.
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So none of that happened overnight.
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But what I can say is, you could feel the momentum changing from skepticism after we made the announcement over a couple of months to, well, here's what this means, education on it,
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the blueprint of what's possible, what needs to occur for us to be able to achieve those pieces and laying out that timeline.
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As you mentioned, it's years.
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But once you get through breaking down the different pieces of why the change needs to happen, what are the benefits, and then what are the steps that we need to take in order for that to occur, and you create essentially
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the breadcrumbs in a storyline of how this is going to work.
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It has changed the hearts and minds of so many, certainly from our employee base and galvanizing them around what we needed to get done and creating the energy of people wanting to be a part of this very, very quickly.
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And then the openness from our clients of, you know, employers understanding the challenges because,
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They have families, they have kids.
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And so those even making the decisions, understanding that there has to be a better way and us showing them what that better way could be and how it is going to be more durable and how it solves many of the challenges that they may have today around the unpredictability that's happening within the healthcare space.
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And then ultimately, I think,
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We're seeing that from our competitors as well as they rethink now their position.
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We understand where change is having to occur, and that's hard to lead stepping forward.
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But we're starting to see a change within the entire industry of people talking more like we're talking and moving forward with it, which is exciting to see, too.
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Yeah.
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So how do you deal with those people that have said, oh, you know, we've been doing this this way for 20 years.
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I don't know why you're changing stuff.
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You're crazy.
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We don't believe in it.
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We don't agree with it.
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Do you get rid of those people?
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Do you kind of bring them on board?
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I would imagine that's probably the biggest issue.
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barrier to change, right?
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It's the people, not the technology, the technology you can always figure out, the processes you can always figure out.
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But getting people to get on board with it is not always easy.
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And it sounded like that was one of the roadblocks that you had to overcome.
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So what did you do there?
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So first and foremost, I welcome the skeptics.
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They help you to get better.
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and ensure that you have sound judgment in what you're moving forward with.
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We also really encourage free flow of information, regardless of your role within the organization.
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If you have good ideas, stepping forward, if you've got an opinion that has real substance that we need to consider, all of those things are valued within, need to be valued within an organization.
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So not being afraid to have those conversations
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and being open to listen and people ensuring that they're heard of what challenges that they may want to put up on where we're going and did we think of this, did we think of that?
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All of those pieces helped us become better.
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And you have to balance taking in that information with also being ready to step forward.
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So it's the flexibility of
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taking those hard steps and moving forward once you've set the direction of where you're going to going be being ready to go but yes you've got to be flexible enough to pivot if there are many things that you haven't thought of or we've made mistakes along the way and we have to make some adjustments with how we're going to engage with different stakeholders so taking that information in again and realizing that
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how we thought about it the first time might not have been the best way and we're willing to adjust.
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We're gonna do that quickly and move forward.
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You're not gonna have the full view of everything you need to get done, especially in something that's complex as changing a full business model when you start.
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But that's okay because if you wanna spend five years planning and then another five years building, your five-year example becomes 10.
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And we take much more of a different type of approach of months of planning.
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You're going to learn a lot along the way to your point.
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Markets can evolve a lot as you're going.
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And so it's important to be moving towards transforming and changing, but then having building in the flexibility from a technology perspective to make those adjustments so that you stay nimble within within the market.
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But you're still moving forward.
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Got it.
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And last question for you before we wrap up.
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For people who are watching and listening, they're going through a transformation inside their organization.
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If there were, I don't know, two or three pieces of advice that you could give them on how to make these transformations successful, assuming they're also multi-years, what advice would you have from some of the things that you've learned and seen?
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Yeah.
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A lot of this, we leverage technology a lot and we're going to leverage it even more going forward.
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But I still think a lot of this comes back to the people and ensuring that you can find the smartest, most creative and innovative types of people that are highly motivated to deliver on
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what a future can be and not accepting the status quo is one.
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So you've got to surround yourself with people that are willing to do that, challenge each other, but are going to be in this and have that resilience to carry it forward.
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Two, I would go back to you have to have speed and purpose with that element of flexibility.
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So not having all of the answers, I'm much more in the thinking of we have to move.
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If we're gonna build a building, we have to make some adjustments within the building, that's fine, but then you've gotta continue to move forward and not being afraid to have
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a lot of micro failures along the way, but being able to pick those up, identify them quickly, make the adjustment you need to, and keep moving forward.
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I think that's what's needed regardless of what industry that you're in, and especially in the new world that we're going to be in.
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Moving, that's gonna move faster, which means we as business leaders are gonna have to continue to move faster as well, and be able to leverage the
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all the different new components that we're going to have to consider and new advantages that AI is going to bring us as we move forward.
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But that to me means it's an exciting future for leaders and organizations that are willing to step up to that challenge.
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I'm optimistic as well.
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So I'm not one of those doomers when it comes to AI.
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I see a lot of potential, a lot of opportunity.
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Sounds like you do as well.
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Adam, where can people go to learn more about you?
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Anything that you wanna mention for people to check out?
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I would encourage you to go to our EverNorth Health Services website.
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EverNorth provides a broad aspect of the services across the healthcare industry.
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And there you can learn a lot around what we're able to do, thinking differently.
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We're continuing to push the status quo here at Evernorth Health Services and look forward to being able to do that and helping people be able to access their health care when and where they need it in an affordable way long term.
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Adam, thank you so much for taking time out of your day.
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Really appreciate it.
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All right.
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Thanks, Jacob.
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Have a great day.
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Appreciate the time.
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Hello, everyone.
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Welcome to Future Ready Leadership.
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My guest today is Adam Kotzner, President of EverNorth Care Management and Express Scripts and EVP of Customer Personalization for the Cigna Group.
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Adam, thank you for joining me.
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Thanks for having me, Jacob.
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Appreciate the time.
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Yeah, I'm looking forward to the conversation.
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Today, for those of you who are tuning in, we're gonna be talking about navigating through the critical middle of a major year, multi-transformation.
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So lots of organizations are going, whether it's AI transformation, whether it's acquisitions or mergers or regulatory, every company these days is going through some sort of major transformation.
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So Adam's gonna unpack
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how to make those things successful and what he's learned through some of the big transformations he's been involved in.
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So, Adam, maybe high level, why don't we just start with background information about you and the company in case people are not familiar with it?
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And then introduce the transformation that you guys are going through.
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Sure.
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Yes.
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Happy to do that.
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So I'm part of the Cigna Group.
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Cigna Group has...
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three major businesses within the healthcare space, one being Cigna Healthcare, the other being our pharmacy benefit services business within the Evernorth Health Services, which I lead, and then we have a specialty and care division as well.
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Our goal is to improve the health and well-being of patients across America.
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We serve well over 100 million Americans in many different ways to meet their health care needs.
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My specific role in leading our pharmacy benefit services where we do serve over 100 million Americans, predominantly employers, health plans and labor unions.
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And our goal is to
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improve the access and affordability of medications for patients.
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And I'm a pharmacist by training.
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I have been in the industry for over 25 years, been in Express Scripts for about 18 years now and enroll over three years in leading this organization.
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And throughout my time in health care, we have continued to focus on innovation and change.
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The speed at which we continue to develop new drug therapies has become lightning fast.
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And it's going to continue now with AI as manufacturers continue to develop new solutions and new products.
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And that's exciting.
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But it also comes at a time where we have to balance the access and affordability components and ensure patients are getting the drugs that they need most.
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And that's exciting.
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those that are going to have the best effect for them.
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And our focus right now within the pharmacy benefit services area is, yes, working towards transforming our business into something that's brand new, which I'm sure we're going to get to talk about today.
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But I have the opportunity here to have a 360 degree view on the perspective of a meeting directly with our patients, but also our clients that we serve as employers,
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And then ultimately how we're able to enact across the drug supply chain to ensure that from a healthcare perspective, we continue to navigate those things and balance the access and affordability components.
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And how many employees do you guys have?
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So our organization in total has over 60,000 employees.
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employees within our pharmacy benefits business.
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We have several 1000 employees plus all of our operational colleagues that are there to help patients and providers be able to access the healthcare they need.
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Okay, so massive, massive organization.
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So why don't we unpack a little bit some of the transformation that you have been going through.
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So I can't remember how long how long have you been at the company?
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Over 18 years.
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18.
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Oh my goodness.
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It's a long time.
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So what are you guys actually going through as far as transformation right now?
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So the pharmacy benefits business in total is going through quite a bit of transformation across our industry.
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We spent the last couple of decades in a business model that was working well to serve
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our clients and also to serve patients.
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But we realized a couple of years ago that we needed to continue to drive
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a better predictability for our clients and ultimately for patients, improving that affordability and access and being able to ensure that we were able to simplify the pharmacy benefits.
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They've become much more complex over the years and over the decades.
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And so we took it upon ourselves a couple of years ago to think differently, to start
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at the very beginning and re-engineer with the patient as the center of what we're working to try to solve and then working back from there across the entire industry.
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And so that's led to our new signature pharmacy benefit services that we launched back in October, which essentially,
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completely changes the pharmacy benefit model, putting the patient first, delivering new, predictable economics for them so they can access those drugs they need.
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And it will set us up for a much better future, both from a patient perspective, but also for employers as we work towards the future.
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So can we go a little bit deeper into that?
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So what was it like before versus what is the kind of new version like?
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So if I was a patient and I wanted to get a prescription or something like that, can you kind of explain the before and after?
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Sure.
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So today, when you go to the pharmacy counter, in many cases, especially if you're taking a branded drug that may be high cost, you may not know what the cost of that drug is going to be.
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And in many cases, if you have a deductible or a high cost,
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percentage that you pay, a coinsurance that you're going to pay, you're not sure how high that's going to be and where you are within that deductible phase.
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And those drugs can be really expensive.
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Now, what's negotiated on the backside of that are, in many cases, discounts or rebates that are provided back to plan sponsors or to employers.
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And
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in this new model, those discounts, although today in many cases, those aren't passed back directly to the patient, we're contracting in a new rebate-free model that's going to deliver better predictability.
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So Jacob, you would know, your family would know before you go to the pharmacy counter how much that drug's going to cost.
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We're going to negotiate a discount upfront on your behalf with that drug manufacturer.
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A discount's going to be passed through directly to you at the pharmacy counter.
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It's simplifying the benefit.
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It's improving that access.
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And then from an affordability perspective, on average, for patients in that type of situation, it's going to reduce their costs by 30% or more.
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Okay, so it sounds like before this was all kind of done in a black box.
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You kind of show up to the pharmacy.
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They tell you what you need to pay.
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And then you really don't have any insight on that.
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You kind of just hand your credit card, take whatever you need and go back.
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And so now it sounds like you're opening up the black box and you're explaining the pricing, how it's structured, discounts.
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Everybody has a lot more visibility into basically what's going on behind the scenes.
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Yes, and I would take that even a step further as well.
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So today, you only know what that cost is at that pharmacy that you're going to and whether that's in your pharmacy benefit or you might be pursuing what's the cash price for that drug on a different basis.
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platform, or maybe I can go to a direct to the manufacturer and get a different price from a pharmacy that they're running.
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We're going to bring all of those pieces together.
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So through our, what's called our new price assure functionality, our system's going to go out and find the lowest price, regardless of where it exists in the market.
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Normally that is through your benefit, but sometimes it's not, we're going to find that lowest price.
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Then we're going to keep it within the benefit.
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So you get that lowest price, you get the transparency of a discount now that's applied.
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and you have the, essentially the peace of mind that you're going to get that product, you're gonna get the services, you're gonna get the safety and benefit checks that we do in every prescription, but you're going to get it at the very lowest price that it can be across all the different platforms and we're gonna simplify all of those pieces.
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So yes, it takes us a major step forward from where we are today.
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of you're not sure what the price is, you're not sure if you got the best deal and if that was the best place to get the product at.
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We're taking all of that out of the system so that you can rest assured for you and your family that you're gonna have the best access and affordability to these products.
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Can you unpack like what what does that transformation look like?
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Because for a lot of people, you know, on the surface is kind of like, OK, well, that should be simple, right?
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You just kind of collect a couple of different data points.
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You share those data points with the customer.
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You create a little dashboard with UI and you should be able to do that.
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And I don't know, like a month, two months.
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A lot of people don't understand the behind the scenes of that.
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I remember we had like the CTO of Uber on this podcast a while ago.
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And I was asking the same question.
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I said, well, you know, a lot of people, they just open up the app, they push a button and a car shows up.
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You know, what's so complicated about that?
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And he was talking about the millions of transactions that are happening on a daily basis behind the scenes, the algorithms that are required to route somebody from here to there, how they find somebody, the matching.
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There's just so much stuff that happens behind the scenes that people had no idea was taking place.
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So for you, when you're talking about this transformation where you're basically giving customers more data, more insight into things that they're buying,
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How complicated of a transformation is that?
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And then can you talk about maybe what was required?
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We can go on a people side, on a tech side.
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Like why was this never there before?
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Yes.
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So I, our business no different than, than Ubers and others can, can be extremely complex.
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We'll process over 2 billion prescriptions this year on every one of those prescriptions we do.
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over 18,000 safety quality and benefit checks.
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And every prescription that's processed is gonna go through tens of millions of lines of code to ensure that all those checks and safety can- For one prescription?
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For one prescription, yes.
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So when you start to unpack everything that has to change within our system of how we're going to be interacting with the patient to make sure they have the right information
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how we now will be interacting differently with drug manufacturers.
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And essentially, instead of contracting
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rebates that are paid retrospectively on the back end and they're estimated now, you're gonna get that discount upfront.
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So that completely changes how we have to contract with drug manufacturers and how we're able to apply those discounts so patients can realize that upfront instead of them paying months behind the scenes later on to clients.
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And that also changes the economics at the pharmacy level too.
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So for pharmacies that are dispensing those drugs, it changes those components
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and how they're gonna be compensated, when they're going to be compensated, and how they need to be able to push through those discounts as well from a patient perspective.
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So across the ecosystem, major changes have to occur.
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And what that means behind the scenes is yes, we're gonna be leveraging technology and an artificial intelligence in many cases to be able to build these new components much faster.
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But if you step back from those pieces, the first thing, as I mentioned, of starting with the patient and ensuring that the patients are going to be able to get what they need, when they need it, how they would like to receive it.
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So us engaging with them in a new and more meaningful way and ultimately providing a better overall experience.
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So you walk away.
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It's a much easier interaction.
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You can get what you need and move on with your day.
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And all of us today are dealing with the hyper speed of life.
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We wanna make sure from a prescription benefit perspective, that's also here and able to happen.
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And so starting with the patient, then stepping back and how we engage with drug manufacturers and certainly with pharmacies.
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And then ultimately with our clients, because our clients buy these services from us.
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We have thousands of clients, mainly employers.
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And so how they will interact with us
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buy these services from us, those components have to step back and change as well.
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So the full transformation as we looked across and understood the unpredictability that may exist today and how those things need to change, especially with high cost branded drugs continuing to escalate, that affordability gap continues to be a larger challenge, even though
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the demand for prescription services continues to increase.
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It's the most utilized benefit within healthcare.
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And so we needed to step in and provide a better way.
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And that's where the hard leadership decisions come in, right, of understanding that not just fixing what's broken, but also recognizing when a full model change needs to occur and having the perspective to take that head on and us to step through it.
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Why is it so many lines of code for one prescription?
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I think you said like 10 million or millions of lines of code.
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Is it like, is it because, I mean, like if I go and I get a prescription, I mean, I don't know what happens to it behind the scenes.
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It's kind of like when you check in luggage for a plane, it gets, you know, you drop it off at the kiosk and then you don't know the tunnels that it has to go through in the airport before it gets to the plane.
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So in this case for prescriptions, what is happening behind the scenes?
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Why is it so much code that's required?
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So those 18,000 safety quality and benefit checks that we do on every prescription, that's what much of that code is occurring to make sure that we're running all the different side effects to make sure that that drug is safe for you.
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And we're flagging any issues that might have to occur.
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We're running your prescription history that we have on you to make sure
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that there aren't any drug interactions that might have to be flagged or adjustments made.
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And then ultimately, for your own pharmacy benefit, that's how much it's gonna cost and where you are in your deductible phase and those types of components as well.
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So a lot goes into every prescription and in each transaction behind the scenes.
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So how does AI play a role in that?
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I mean, I would imagine, for example, let's say I go get a new prescription for something and I'm already on, I don't know, let's say three or four different drugs.
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I don't know, blood thinner, something for cholesterol, something for who knows what.
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And let's say I get a new drug that's prescribed for, I don't know, sleep or anxiety or something like that.
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Is AI kind of checking everything behind the scenes and looking at the site?
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Like, is that where AI gets used as one potential example to kind of verify and cross check side effects and things like that?
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So today, in most cases, no.
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In most cases today, all of those pieces are still hard coded into the system.
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Future state.
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AI will become a much greater part of what's leveraged across healthcare.
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In total as, but the integrity of how AI is going to be used,
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the accuracy of AI within healthcare has to be much better than what humans can do today before those components are going to be leveraged.
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Where we're using AI today and where we see it future state certainly is, yes, the speed at which we'll be able to interact and develop and put change in to improve the flexibility within the healthcare systems and the speed at which we're able to administer those pieces
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the consistency, and then ultimately the quality.
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But AI still has a long way to go, although we're seeing massive improvements as each month goes by.
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But ultimately, we'd like to get to a point where each patient may have their own AI agent.
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and their ability for that agent from a healthcare perspective to help them navigate through the system.
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It's a curated process then from a patient perspective so that patient isn't caught in the middle.
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And they can navigate that change and be able to have a much better overall experience where AI can be able to interact.
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So that overall member or patient experience is where I think AI will really be able to shine.
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And the behind the scenes, yes, from an operational perspective,
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just the speed at which we'll be able to work and improve the overall quality of our systems is also gonna be a very helpful place for AI to eliminate those, in some cases, tens of millions of lines of code on each prescription and be able to simplify those components in a new way.
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Well, it's funny, I hooked up my chat GPT account, my health account, right?
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They have, I think it's OpenAI Health or ChatGPT Health, where basically it looks at all your medical records that you have through whatever your healthcare provider is,
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And you can ask it questions and it'll analyze everything for you and answer those types of questions for you, which is fascinating because even for me, you know, if I want to, if I have a question for a doctor, he'll say, I need to go talk to this person.
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That person will say, I need to go talk to this person, make an appointment here.
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And to get basic answers or get a comprehensive view of your health could take, I don't know, several weeks before you even get somebody on the phone.
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Uh, and then you don't even know if they reviewed everything.
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Like there've been several times I go to the doctor and they ask me questions and I'm like, did you review any, like I got sent over here.
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Did you review anything over there?
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Uh, so with AI though, it's fascinating that it just, it, it has all the scans, all the blood work.
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It can tell me what vitamins I need, what supplements and why the pros, the cons.
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Uh, and it's, it's, I mean, it's amazing.
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You know, it looked at all the things that I was taking.
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It said, OK, remove this, add this.
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This does the same as this.
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And so the insights you can get from these tools, I think, is just fascinating.
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I agree.
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And I think.
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Yes, it will become second nature for many of us in the future of it already is starting to be.
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a component of your daily life and how you're utilizing it.
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I do think within healthcare though, there are still aspects where the accuracy of that information still has to improve and it will continue to learn as we continue to put more technology components into it.
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And that's where we'll be able to improve the personalization of those components, but ensuring that you are getting the most accurate information today, we may inherently in some cases,
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trust AI, but we've all had the experiences where it gives you back something that doesn't make sense.
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And that's within the healthcare space, that could be a dangerous component that we have to ensure doesn't happen and why we'll have to take more pragmatic steps than being able to put that out really, really quickly.
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Yeah, I've certainly had situations where AI will give me some information or insight.
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I'm like, what are you talking?
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There's no way that this is correct.
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And then you verify it.
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And of course, it's wrong or it hallucinated or whatnot.
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I'm curious on the transformation side, maybe we can dive a little bit deeper.
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How long of a process?
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How much does it cost?
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How did you get people on board?
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What were the details of the transformation and getting from point A to point B?
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So I love innovation.
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I love the transformation changes and those journeys that you're able to get on from a business perspective and the benefits that it can drive.
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But it's hard work and in some cases can take a long time.
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First, recognizing that that change has to occur and that a bold step is going to be needed, figuring out what that bold step is, right?
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That spark of the innovation and change that you need to be able to transform that creates quite a bit of excitement around what can be possible for a very bright future and setting that bold vision of where you're particularly going.
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But once that's done, you can think of that as the,
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the big press release, whether that's internally within a business or it's externally to the world of where you're going, then that hard work sets in.
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And that's what I would call the critical middle of
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So the excitement is there, but now the realization of the work has to get done, the complexity of everything that needs to happen, and the sheer force of an organization now has to move in a direction it may not want to move in, or it wasn't built to move in.
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And so that change is gonna be hard, and there's a lot to work through.
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And so staying with it, motivating leaders to be able to step forward into those spaces and create opportunities to be able to,
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learn fast, be able to fail fast where you have to, but continue to move forward each and every day to be able to stay on those timelines.
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And that can be an overwhelming time.
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But ensuring that there is appropriate leader accountability during that time, there are appropriate motivations that are there, and that you're creating trust within a core team that can work through those pieces.
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That's going to define whether you're successful or not.
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And leaders can't
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can't ignore that hard work in the critical middle after something's built up.
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You can't walk away from it.
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You've gotta stay in it and be able to ensure that you have
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the right teams in place with the right focus and expertise to be able to deliver on what ultimately is the outcome that you are looking to be able to deliver on.
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And that's a time too of, often we start with one place in a journey, we think we're going to a place and you lose your way, but staying on the right path to ensure that you're delivering on
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what the ultimate goal on is really really important as you step through that type of transformation and we are in the midst of one of those right now as we talked about the pharmacy benefit space where we are from an announcement last october to today but the work started a year before all of those things of what could be possible and so
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taking an organization on a journey like this, it has a little bit of a leap of faith of the work that has to get done in, in the future.
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But if you have that destination state in mind and,
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You know that the status quo is unacceptable going forward and change must occur.
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It creates that resilience within an organization to be able to deliver on something that in a lot of cases people thought may not have been possible, but you make it possible.
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And that's really, really rewarding from a career perspective, not only for the leaders, but also for those that are able to be a part of it going forward.
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So you said you started this around a year ago, is that correct?
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We started developing and having conversations on it a year and a half ago.
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We made an announcement this past October.
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So we've been in this for quite some time of realizing first change needs to occur,
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Many times, often when you've identified problems, you look at incremental change as the first answer.
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It's always the, potentially the easiest answer of what could I tweak, what could I adjust.
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But in this instance, and I think in many instances across all industries, you come to a point of, transformation really is needed.
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You have to think about this in a brand new way.
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And although it can be scary, it also can be
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be really rewarding.
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And as long as you have that right destination, it's one that an organization can pick up and be successful with.
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And how much longer do you have in this process, do you think?
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For our particular transformation within the benefits space, we'll be bringing some of our components from our Cigna Healthcare within the
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next year and then the rest of the market could go live as early as as 1-1-28 so start to finish it's it's going to be a few years before we we see it fully in in practice and then we'll have more and more of our clients be adopting it from 2028 and beyond so a lot of education is occurring right now on this transformation in the industry and how we're going to be doing things differently
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But that's such a crazy long time to go through.
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I mean, three, four years in today's fast moving world seems like an eternity.
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So how do you like if somebody were to tell me, hey, Jacob, you know, you're you're unhealthy and you can get healthy, but it's going to take you four years to do it.
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I'd be like, oh, my God, four years.
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You know, it's it takes too long.
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You know, people are so used to faster goals, instant gratification.
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So to tell a team of 60,000 employees, hey, we're going to be working on this project, it's going to take probably four years, if not longer, to get from point A to point B. Yeah.
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I mean, how do you get the momentum, the excitement, like kind of keep it there?
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It just, you know, you might not even have the same workforce at that time because people might retire or quit or get hired.
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So how do you manage such a long, you know, almost half a decade transformation for an organization that's so large?
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That's a great question.
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In the beginning, much of that is the
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innovation side, the time of smaller teams and groups working on what that future could be, right?
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So that's- It's the fun stuff.
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A year of that time off, but then you start the, yes, the actual hard work of motivating an organization and yes, pulling it forward.
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And yes, regardless of what level in the organization people are at, they need to be excited about the change.
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In healthcare,
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We have a bit of a bonus, I would say, of the higher calling of helping people.
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And this is a way for us to be able to do that.
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So having that patient in mind of what really has to change in order to develop a much better experience and health outcome for a consumer is motivating for so many of my colleagues and leaders and our ability to be able to change.
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having the right motivators in place for an organization is critically important and one that you can't skip over.
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Yes, there might be something that's right for the consumer, your clients and your business, but ultimately you have to be doing it for the right reasons.
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And that's the part that is going to be durable and have the resilience as you move through.
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And then certainly there are other components of ensuring that we have
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milestones that can push you through that critical middle, and that you're developing new components of what your destination was going to be, or the program was going to be, in different time periods throughout that journey, which means you're gonna realize a lot of things along the way that you hadn't figured out, or you need to figure out, and those become other small,
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micro innovation components within the overall journey of the pieces.
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And that also can be very motivating to our teams and to our leaders.
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And we create much more of a family atmosphere as well of we're in this together, we're going to build this together and be able to deliver something that is meaningful.
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And as you said, many people may be leaving an organization, they may retire,
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A transformation like this is from a career perspective, we do it right.
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It may outlive many of us in terms of our time within the healthcare space as professionals.
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And that's rewarding too.
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From a legacy perspective of changing whatever business you're in, for us it's healthcare,
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And that's going to have a durable effect that's going to be good for your family and your children, potentially for years to come until another transformation is needed after that.
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Yeah, it's funny.
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So I have two younger kids, a six year old and a soon to be 10 year old.
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My 10 year old daughter plays competitive chess and soon to start tennis.
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And my son is really interested in all things like robotics and technology.
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And so we're constantly having these conversations about how the things they're doing now are going to kind of shape who they are later.
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So, for example, my son right now, he does these little robots called VEX IQ.
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And so he says he wants to be a roboticist, an engineer, and he wants to build these really crazy things.
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But right now he's just building these kind of basic Lego techniques and plugging things in and messing around with little wires.
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And so for him, making the connection between something little that I'm doing now, playing with toys versus working in a...
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I don't know, robotics factory is a, it's like a, such a long-term stretch.
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And even same thing for my daughter, who's a chess player.
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Um, you know, she's turning 10 and sometimes she'll have a bad tournament or a bad game.
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And I'm trying to get her to think long-term, right?
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Imagine where you're going to be when you're 12, when you're 13, when you're 15, and,
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And so sometimes I think for people, it's very hard to imagine the future state, especially if it's several years away.
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Are you finding that you're constantly having to reinforce that future state for your workforce?
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You know, like the day to day, right?
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I mean, you have people who are showing up every day, they're coding, they have to be on the phone, building relationships, negotiating new things, probably for this kind of future state that you're building.
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Yeah.
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How do you constantly keep the narrative, the story of like, here's what we're getting to in a couple of years, right?
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Imagine this, imagine that.
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Cause you need a lot of that.
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Otherwise people just, it just turns into kind of a new day to day, it's just my new job, new work.
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Yes, it's not an easy task, but, and you're right, we are today doing things in a,
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the old way with some incremental improvements before you move to the full transformation.
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So you're having to do multiple things at once, which means people are having to work harder, deliver more, and it takes even more dedication to be able to get all of that done.
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But if I go back to creating the right atmosphere and building things together,
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and our ability to incrementally continue to improve those pieces and working in collective teams, those aspects can be highly motivated, motivating.
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We also create
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micro destinations within these different timelines to ensure that you're still getting to some type of achievement or milestone.
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It can't be just the achievement that's going to happen in two or three years to be able to
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reward employees in different ways and be able to celebrate the successes and getting over some of the most challenging things that you might face in a very long and complicated type of transformation like this.
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I also think it gets easier.
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If I think about even your son and robots, or you think about AI and where we are today and where we'll be in the future, the compounding effect of doing some
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hard things together, it gets easier to do more hard things together and bigger things that are even more difficult to do because you do have that compounded effect.
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No different than in technology and AI of a compounded technology component of it's going to get easier as you do more and more of those complex things and you get that muscle memory and that becomes even
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more fun of doing those and meeting those challenges together, which creates much more momentum to be able to sustain something that takes a long time to do from a race perspective in many cases.
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So there are a lot of different aspects I think you have to look at this from of what motivates individuals, what motivates teams, what motivates different leaders to be able to deliver on a complex,
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transformational type of change that many organizations have to go through periodically.
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Yeah, I like that mentality.
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I mean, I frequently tell my kids, do the hard stuff first.
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And then the more, if you can get used to the hard stuff, you like the process, then yeah, over time it does become easier as opposed to just kind of throwing something difficult at somebody one time and expecting them to solve it.
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So yeah, I mean, I can see how that makes sense, where if it's kind of a longer term transformation, you get more acclimated, you get more used to it, and it becomes a little bit easier for that process.
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Yeah.
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Um, have you had any stumbling blocks in the transformation process so far?
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Like pushback from leaders, employees who lose direction or vision, or has it just been smooth sailing for you guys?
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Oh yeah, completely not smooth sailing.
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You're always going to have a lot of different, you know, when we, when we made our announcement there, there, there was skepticism from competitors of how you're going to do this from, um,
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even some clients of how would this work?
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I've been doing it the same way for 20 years, 30 years.
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And now all of a sudden you think you can change this.
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And so, yeah, there has been a lot of education that it's taken even internally.
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Yes, you're right.
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Of employees have spent their entire careers doing it one way and now,
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that we said, well, there's a better way.
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And here's the better way.
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And good news, you're gonna get to help build this new way that we're going to be able to change an entire industry on.
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So none of that happened overnight.
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But what I can say is, you could feel the momentum changing from skepticism after we made the announcement over a couple of months to, well, here's what this means, education on it,
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the blueprint of what's possible, what needs to occur for us to be able to achieve those pieces and laying out that timeline.
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As you mentioned, it's years.
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But once you get through breaking down the different pieces of why the change needs to happen, what are the benefits, and then what are the steps that we need to take in order for that to occur, and you create essentially
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the breadcrumbs in a storyline of how this is going to work.
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It has changed the hearts and minds of so many, certainly from our employee base and galvanizing them around what we needed to get done and creating the energy of people wanting to be a part of this very, very quickly.
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And then the openness from our clients of, you know, employers understanding the challenges because,
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They have families, they have kids.
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And so those even making the decisions, understanding that there has to be a better way and us showing them what that better way could be and how it is going to be more durable and how it solves many of the challenges that they may have today around the unpredictability that's happening within the healthcare space.
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And then ultimately, I think,
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We're seeing that from our competitors as well as they rethink now their position.
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We understand where change is having to occur, and that's hard to lead stepping forward.
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But we're starting to see a change within the entire industry of people talking more like we're talking and moving forward with it, which is exciting to see, too.
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Yeah.
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00:38:33.149 --> 00:38:39.794
So how do you deal with those people that have said, oh, you know, we've been doing this this way for 20 years.
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I don't know why you're changing stuff.
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You're crazy.
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We don't believe in it.
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We don't agree with it.
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Do you get rid of those people?
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Do you kind of bring them on board?
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I would imagine that's probably the biggest issue.
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barrier to change, right?
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00:38:52.436 --> 00:38:57.079
It's the people, not the technology, the technology you can always figure out, the processes you can always figure out.
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But getting people to get on board with it is not always easy.
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And it sounded like that was one of the roadblocks that you had to overcome.
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So what did you do there?
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So first and foremost, I welcome the skeptics.
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They help you to get better.
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and ensure that you have sound judgment in what you're moving forward with.
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We also really encourage free flow of information, regardless of your role within the organization.
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If you have good ideas, stepping forward, if you've got an opinion that has real substance that we need to consider, all of those things are valued within, need to be valued within an organization.
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So not being afraid to have those conversations
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and being open to listen and people ensuring that they're heard of what challenges that they may want to put up on where we're going and did we think of this, did we think of that?
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All of those pieces helped us become better.
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And you have to balance taking in that information with also being ready to step forward.
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So it's the flexibility of
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taking those hard steps and moving forward once you've set the direction of where you're going to going be being ready to go but yes you've got to be flexible enough to pivot if there are many things that you haven't thought of or we've made mistakes along the way and we have to make some adjustments with how we're going to engage with different stakeholders so taking that information in again and realizing that
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00:40:39.045 --> 00:40:43.068
how we thought about it the first time might not have been the best way and we're willing to adjust.
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We're gonna do that quickly and move forward.
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00:40:47.070 --> 00:40:57.057
You're not gonna have the full view of everything you need to get done, especially in something that's complex as changing a full business model when you start.
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But that's okay because if you wanna spend five years planning and then another five years building, your five-year example becomes 10.
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00:41:06.482 --> 00:41:10.766
And we take much more of a different type of approach of months of planning.
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00:41:10.886 --> 00:41:13.088
You're going to learn a lot along the way to your point.
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Markets can evolve a lot as you're going.
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00:41:15.570 --> 00:41:28.082
And so it's important to be moving towards transforming and changing, but then having building in the flexibility from a technology perspective to make those adjustments so that you stay nimble within within the market.
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00:41:28.122 --> 00:41:29.363
But you're still moving forward.
394
00:41:30.872 --> 00:41:31.132
Got it.
395
00:41:31.673 --> 00:41:33.254
And last question for you before we wrap up.
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00:41:34.175 --> 00:41:39.219
For people who are watching and listening, they're going through a transformation inside their organization.
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00:41:40.220 --> 00:41:51.971
If there were, I don't know, two or three pieces of advice that you could give them on how to make these transformations successful, assuming they're also multi-years, what advice would you have from some of the things that you've learned and seen?
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00:41:51.991 --> 00:41:52.091
Yeah.
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A lot of this, we leverage technology a lot and we're going to leverage it even more going forward.
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00:42:02.724 --> 00:42:15.498
But I still think a lot of this comes back to the people and ensuring that you can find the smartest, most creative and innovative types of people that are highly motivated to deliver on
401
00:42:16.764 --> 00:42:20.885
what a future can be and not accepting the status quo is one.
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00:42:20.905 --> 00:42:30.648
So you've got to surround yourself with people that are willing to do that, challenge each other, but are going to be in this and have that resilience to carry it forward.
403
00:42:31.529 --> 00:42:42.412
Two, I would go back to you have to have speed and purpose with that element of flexibility.
404
00:42:42.745 --> 00:42:48.609
So not having all of the answers, I'm much more in the thinking of we have to move.
405
00:42:49.190 --> 00:42:58.637
If we're gonna build a building, we have to make some adjustments within the building, that's fine, but then you've gotta continue to move forward and not being afraid to have
406
00:42:59.131 --> 00:43:08.958
a lot of micro failures along the way, but being able to pick those up, identify them quickly, make the adjustment you need to, and keep moving forward.
407
00:43:09.779 --> 00:43:17.524
I think that's what's needed regardless of what industry that you're in, and especially in the new world that we're going to be in.
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00:43:18.485 --> 00:43:28.632
Moving, that's gonna move faster, which means we as business leaders are gonna have to continue to move faster as well, and be able to leverage the
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00:43:30.299 --> 00:43:39.003
all the different new components that we're going to have to consider and new advantages that AI is going to bring us as we move forward.
410
00:43:39.043 --> 00:43:47.227
But that to me means it's an exciting future for leaders and organizations that are willing to step up to that challenge.
411
00:43:48.355 --> 00:43:49.395
I'm optimistic as well.
412
00:43:49.615 --> 00:43:52.376
So I'm not one of those doomers when it comes to AI.
413
00:43:52.476 --> 00:43:54.336
I see a lot of potential, a lot of opportunity.
414
00:43:55.477 --> 00:43:57.497
Sounds like you do as well.
415
00:43:58.037 --> 00:44:00.638
Adam, where can people go to learn more about you?
416
00:44:01.038 --> 00:44:03.339
Anything that you wanna mention for people to check out?
417
00:44:05.399 --> 00:44:10.060
I would encourage you to go to our EverNorth Health Services website.
418
00:44:10.860 --> 00:44:17.162
EverNorth provides a broad aspect of the services across the healthcare industry.
419
00:44:17.783 --> 00:44:23.906
And there you can learn a lot around what we're able to do, thinking differently.
420
00:44:24.526 --> 00:44:40.652
We're continuing to push the status quo here at Evernorth Health Services and look forward to being able to do that and helping people be able to access their health care when and where they need it in an affordable way long term.
421
00:44:41.653 --> 00:44:43.594
Adam, thank you so much for taking time out of your day.
422
00:44:43.614 --> 00:44:44.294
Really appreciate it.
423
00:44:45.322 --> 00:44:45.564
All right.
424
00:44:45.644 --> 00:44:46.268
Thanks, Jacob.
425
00:44:46.328 --> 00:44:46.912
Have a great day.
426
00:44:46.992 --> 00:44:47.757
Appreciate the time.
