Cigna Case Study: Reputational Challenges in a Time of Industry Change

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Cigna Corporation Case Study Reputational Challenges in a Time of Industry Change

Faith Jackson Strategic Reputation Management MCIS 17:194:505 Prof. Ruth Ellen Kinzey 5/09/14

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Cigna Corporation Case Study Reputational Challenges in a Time of Industry Change Introduction Cigna Corporation is a multibillion-dollar global health-insurance company providing health care products and services, disability, life, and accident insurance, as well as international insurance coverage (Cigna Corporation Fact Sheet, 2014). In the United States, it is known primarily as a medical- and dental- health insurance provider and is the seventh-largest of its kind in the country (Heilbrunn, 2013). By the end of 2013, Cigna's stock value rose by 60 percent, a higher percentage than any other major healthcare insurer (Street, 2014, para. 4). These facts may lead Cigna to a false sense of security. However, the organization's corporate leaders need to read the signs that their reputation is at risk. The first concern is an external force: a change in the marketplace affecting the entire industry. The implementation of federal health-care reform known as the Affordable Care Act (ACA) has caused 7.1 Americans to enroll for new healthcare plans (Jackson and Madhani, 2014, para.

1). Health-insurance organizations with positive reputations are in position to experience unprecedented growth. At this time, every insurer needs to evaluate its reputational challenges and mitigate them to be in the best position to attract potential new customers.

Corporations like Cigna can only prepare for and respond to sweeping external changes like the ACA. They have more control over other reputational concerns specific to their own actions and practices. Corporate reputation can be considered “an enduring collective representation of a firm's past behavior” (Romeneti, 2013, p. 307), formed through a clearly defined and consistent corporate identity, employee ambassadors who establish authenticity and trust, alignment between the company's values and behaviors, and stakeholder engagement (p. 307-308). By this definition, Cigna has a reputation problem. Many customers are frustrated with its services; many employees are unhappy with its expensive and limited health care insurance; and various claims practices perceived as unethical have led to an overall lack of public trust. Each of these signs ultimately point to a single potentially fatal flaw: Cigna does not always act in alignment with its own mission, which is “to help improve the health, well-being and sense of security of the people [it] serve[s]” (Cigna Corporation Newsroom, 2014). The company will need to make innovative changes grounded in its mission to improve its reputation and survive and thrive in the new healthcare environment.

Reputational Challenge 1: A New Healthcare Environment and a Different Consumer Type The ACA is complex, but the aspect that has brought new customers into the market is its individual mandate, which requires all adults to hold health care insurance or pay a penalty. At this time, Cigna has already benefitted from the ACA, with increased profits (Adamopoulous, 2014, para.

2) and higher stock value (Street, 2014, para. 4). They could continue to benefit, attracting even more of these new customers from other insurers as contracts expire. However, Cigna must consider that these new consumers are not subject to employer-sponsored plans and are not limited to the handful of plans an employer has chosen. They have more freedom to choose from any health insurance plans available where they live. Further, some economics and health-care experts believe that the changes brought by the ACA will ultimately lead to the end of employer-sponsored insurance plans, with 90

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percent of adults predicted to be purchasing health insurance directly from government exchanges by 2020 (Irwin, 2014, para. 4). These circumstances mean that consumer satisfaction is more important than ever before. Customer retention is based in part on trust and loyalty which is established more by direct experience of what the organization does than any specific messaging (Varey, 2013, p.188-189), so consumers will not trust a company that says one thing and does another (p.188-189). For the best chance of retaining current and attracting new customers, Cigna needs to demonstrate that it is a champion of its own mission.

Reputational Challenge 2: Poor Customer Service Any organization selling products knows customers are among its most important stakeholder groups. For Cigna, this is particularly significant since its mission includes improving “the health, wellbeing and sense of security of the people [it] serve[s].” Unfortunately, Cigna has frustrated and alienated many of its customers. A Harris Interactive poll placed Cigna “below category average” in a study on consumers' perceptions about health insurance brands (Harris Interactive Press Release, 2013, para. 9). Some reasons for this perception can be found on social media, which as a medium now has a greater effect on a company's reputation than any of its own messaging (McCorkindale, 2013, p. 756).

The organization is so notorious for poor service that that it was the subject of an article on The Onion, the satirical news website known for its incisive social, political, and pop-culture commentary. In the story, Cigna was described as celebrating the fact that it had angered its “50-billionth [expletive] customer” (The Onion, 2012, para. 1). Though meant in fun, this insight is based on fact and the article has been widely shared on social media. In a review of Cigna's Facebook page (www.facebook.com/CIGNA) on March 3, 2014, all but one of the most recent twenty posts made by customers were extremely negative. In a similar content analysis of twenty consecutive posts to its consumer question Twitter feed (twitter.com/cignaquestions) on March 4, 2014, nineteen were negative complaints and one was a neutral question. Cigna also has dismal ratings on consumer-review websites such as consumeraffairs.com, eopinions.com, and insuranceusa.com. Among the common complaints are long telephone hold times, misinformation from customer-service representatives, complex paperwork, and delays in receiving insurance cards and materials. Cigna's customer-service problems appear to stem from two root causes: product complexity and poor service from customer-facing employees. In many cases, these problems directly affect customers' ability to receive needed healthcare services. Cigna's customer-service practices have negatively affected individuals' health and well-being and created insecurity in their lives—the opposite of their mission.

Reputational Challenge 3: Expensive and Limited Health Care for Employees It is well established that workplace environment as an important indicator of corporate reputation (Jiang, 2013, p. 490). Many aspects of organizational behavior such as culture, growth opportunities, diversity, and financial security can also be considered significant in establishing a positive workplace. However, the most important factor seems to be consistency between organizational values and behavior, which establishes credibility with employees (p. 493). Employees working for a corporation demonstrating such consistency will then in turn communicate these values to stakeholders (p. 494-495). At Cigna, workers see a significant disconnect between behavior and the goals expressed by their mission statement. Overall reviews by current, former, and prospective

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employees on glassdoor.com are middling, with 3.1 out of 5 stars. Fifty-nine percent of reviewers indicate they would recommend the company to a friend. Both of these statistics are average for large health insurance companies. However, one fact stands out as problematic. Glassdoor.com summarizes the top negative and positive comments about the companies on its site. Among the leading “cons” for Cigna is that health-insurance benefit costs are high and services poor. A health insurance company ought to provide its employees with exceptional health coverage at a reasonable cost to be consistent with its mission.

Reputational Challenge 4: Unethical Claims Practices Lead to Loss of Public Trust The reputational challenges Cigna faces with customers and employees have an ethical component. The company is acting in a hypocritical manner and not treating either group in a way that fully aligns with its mission. However, the most significant concern affecting the organization's reputation is a more serious ethical problem that is both industrywide and specific to Cigna. Congress and banking are the organizations and industries with the worst reputations (Reckoner, 2013, para. 1), but health insurance providers are not far behind. Whether or not insurers are fully to blame for rising premiums and exorbitant medical costs, these companies are targets for Americans' ire against the health care system (Emanuel, 2014, para. 1). Further, the most common charge is that health insurance companies put profit ahead of individuals' health. It is often said that these organizations create complex rules and loopholes with the sole aim of denying legitimate claims for the sake of profit. As a large insurance company, Cigna will always need to overcome this industrywide reputational hurdle.

Beyond the industry's reputation challenge, a greater concern is that Cigna became perceived as the prime example of unethical claims management during a crisis from which it has never fully recovered. In 2007, the company denied coverage for a liver transplant to a young woman named Natalie Sarkisyan. The reasons for the denial were multifaceted, but public outcry, plentiful negative media coverage, and a lawsuit followed. Ultimately the company reversed its decision, but Sarkisyan died before she could benefit. In recent years, the company has regained much of the ground it lost during the reputational hit it suffered at that time. However, the Sarkisyan crisis is commonly mentioned in contemporary news stories about the ills of the health insurance industry. It is still the prime example used when discussions arise about insurers that put profit ahead of care (Chen, 2011).

Cigna's name is permanently attached to a serious industrywide ethical problem.

The Sarkisyan crisis was not the only example of a time Cigna was perceived as acting in an unethical manner. Cigna communications executive Wendell Potter resigned from the corporation shortly after Sarkisyan died, and has spent the years since speaking out against nefarious practices of insurance companies. He often recounts his own experiences at Cigna as examples, further damaging the company's reputation. Worse, the organization continues to be cited for unethical claim management. While not much publicized, Cigna recently settled a multi-state lawsuit for more than $70 million for “claim irregularities,” some of which included “not giving due consideration to the medical findings of independent physicians,”(Insurance Broadcasting, 2013, para. 3). In 2007, Cigna should have recognized that they had a reputational problem and considered evaluating and changing their insurance claim practices. However, they did not, and the problems continue to this day.

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Addressing the Fatal Flaw: Lead with Change Cigna's underlying reputation problem is that its practices are inconsistent with its mission in key areas of customer support, employee benefits, and claim practices. Having faced a crisis like the Sarkisyan case in 2007 and continuing to settle lawsuits regarding the same practices in 2013 suggests that the organization is operating within a cycle described in institutional theory as legitimacy as rational myths. When this occurs, standardized processes of the business environment are based on habit and “become substitutes for functional reasoning” (Lammers and Guth, 2013, p.357-358). The norms of health-insurance bureaucracy and underwriting might be the typical structure for making profits, but from a reputational standpoint they are damaging to Cigna specifically and the industry as a whole. Cigna leadership should evaluate its customer service practices, workplace benefits, and claims practices and make innovative changes that support their mission. This would differentiate Cigna from an industry currently held in low regard and create positive social capital, which in turn would improve its overall reputation (Luoma-aho 2013, p. 447-448).

A good model for leading change in the industry could be drawn from another concept found in institutional theory, which is that of entrepreneurship. This is the ability to innovate even in the face of conformity and either create new institutions or transform existing ones (Lammers and Guth, 2013, p.

364). A good example of this concept in practice is the recent transformation of ethical practices by McKinsey & Company, a prestigious global financial management firm. Previously, the firm was one of the most respected in its industry, with clients that included heads of state and CEOs of major corporations. In 2010, for the first time in its history, one of McKinsey's parters was charged with violating securities laws and the firm took a significant reputational blow. Partner Dominic Barton used the crisis as an opportunity to “change the culture of the firm that shaped him,” and led reform unheard of in the industry. Initially, many employees resisted, but most eventually relented. The result of Barton's uphill climb is that McKinsey is now considered a change leader that is far ahead of the rest of the industry in ethics practices (Raghavan, 2014, para. 23).

Like Barton at McKinsey & Company, Cigna's leadership could change its own culture and influence the larger industry. They could challenge legitimacy as rational myths, undertake entrepreneurship, and innovate while other companies are entrenched in conformity. It has been established that values such as “credibility, reliability, trustworthiness, and responsibility are central to mulitple stakeholder's perceptions of an organization's reputation” (Jiang, 2014, p. 493). To be considered aligned with these values, a company must be transparent in its performance and in employees' interactions with consumers (p. 493). Cigna, then, can become more transparent and trustworthy by improving customer service, providing employees with the best health insurance and wages in the industry, simplifying products and services, and changing questionable claim practices to restore public trust. Innovating in these areas in ways that realign with the organization's existing mission of supporting the health, well-being, and sense of security for the individuals it serves, will improve its reputation and better the insurance industry overall.

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Guiding Principle: Lead Responsibly and the Profits Will Come Corporate Social Responsibility (CSR) has become increasingly important to consumers, with many indicating that they would switch brands to organizations demonstrating strong CSR (Rifon, Smreker, and Kim, 2013, p. 96). Most people think of CSR as solely engaging in philanthropy or being environmentally responsible. However, it is more than this. While many categories can be—and are— measured to determine how socially responsible an organization is, a new business paradigm connected to CSR has begun to appear that shifts away from a profit-driven, shareholder based approach to a responsible stakeholder-based approach (Pettigrew and Reber, 2013, p. 524). When companies approach their CSR efforts with the goal of specifically improving stakeholder relations and social welfare, they will strengthen stakeholder relationships, generate more support from and encourage less turnover from employees, build customer loyalty, and differentiate themselves from their competitors (Carroll and Shabana, 2010, p. 102). In Cigna's case, the organization should turn some of its CSR efforts to being socially responsible with its own customers and employees.

In the past, Cigna's emphasis on profit has harmed and alienated its consumers and workers.

Instead, the organization could be seen as the industry leader that stands by its mission before seeking profit. The company might initially need to spend capital that would reduce profits in the short term.

However, it has been established that when approached in the right manner, strong CSR practices can ultimately result in financial profits (p. 101). The brand loyalty Cigna would gain would provide the reputational capital and profits it seeks over the long run.

Responsible Change Action 1: Set the Industry Standard for Customer Service Cigna has seen a boost in profits from new customers that have enrolled as a result of the ACA's individual mandate (Adamopoulous, 2014, para. 2). Since many of the new customers are younger and are less costly to insure, the company has increased its profit outlook for 2014 (Jaspen, 2014, para. 1).

However, if these new enrollees have negative experiences with Cigna, they can easily choose another top insurer, since most of them are not tied to a small group of employer-selected plans. Given the number of customer complaints about Cigna that can easily be found online, the company needs to demonstrate strong CSR with its own consumers.

Many online consumer complaints against Cigna indicate that it is hard to find and understand specific plan benefit information. Most customers expect health insurance companies to have provider directories and personalized explanations of benefits for all claims online, and Cigna has already created myCigna.com and a myCigna app to provide these services. The latter has even received positive reviews in both the Android and Itunes app stores. The organization should improve and maximize these tools to address the most common questions so that consumers may find answers to as many of their questions as possible without having to make phone calls. More customized plan information should be online, outlining what is covered and what isn't in clear language that is easy for people to understand.

The most important aspect of online service that must change is claim appeals. In general, the health insurance industry is known for cumbersome and time-consuming appeal procedures (Wahlberg,

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2014, para. 8). A common consumer complaint is that insurance companies make appeals difficult specifically to dissuade people from filing them. A review of the claims and adjustment guidelines on Cigna.com reveals that all types of appeals except one must be mailed, and this is common for most health insurance companies. Cigna could lead the change to enable customers to file appeals as well as track the progress online.

If online functions are improved, fewer customers will need to call Cigna customer service.

However, telephone contact is still important, so changes should be made in this area as well. Offshore outsourcing of customer service functions must stop. Outsourcing is a complex arrangement that can be a financial boon to other countries as well as corporations, but it is controversial in the United States (Jones, 2005. p. 94-96), particularly during times of recession when it is considered socially irresponsible to hire abroad for English-speaking jobs when employment is needed domestically. While outsourcing can be a positive move for a company in certain areas such as IT, it is a mistake for customer-facing functions (Chazal, 2014, para. 1). Typically customers call a company when they have a problem that is not easy to solve on their own. Phone communication can be filled with misunderstandings even with speakers from the same country (Chazal, 2014, para. 3). So, foreign customer service representatives can have even greater difficulty grasping the nuances of complex plan and benefit problems than domestic ones. All customer-facing contact for domestic consumers should be handled by individuals working in the United States.

Having a domestic workforce is a good step in providing better service, but more will need to be done. Customer-facing employees must be trained so that they can provide expert—and caring— support to telephone callers or online chatters. A good model to follow would be that of Apple. Their 5step model to customer service including the values of empathy, communication, listening, expert resolution, and a fond farewell is now considered “legendary” and has been adopted by businesses around the world (Gallo, 2013, para. 1). At Cigna, a new training program could be created so customer service representatives can mirror these standards. Customers want to speak with representatives who are caring and knowledgeable problem solvers that can quickly identify their needs and provide resources to help them. Going back to the idea of having a United States-based workforce, training and updating representatives about Cigna services and processes so that they are caring experts would be simpler and quicker with domestic workers. At the same time, these employees would be able to more quickly notify management of any trends in complaints, or particularly aggressive callers that could damage the reputation of the company online (Herbert and Smith, 2014, para. 7-8). Having a domestic workforce, trained extensively as compassionate subject experts, who provide frequent communication to management would bring the Cigna new life while showing that it truly cares about customers in ways unheard of in the insurance industry.

Responsible Change Action 2: The Best Employee Benefits and Compensation in the Industry All organizations should provide their employees with fair wages and benefits as well as discounts on company products and services. This is of particular importance for Cigna, since it has the care and security of individuals at the heart of its mission. The organization currently offers expensive healthcare with limited options to its workers, and should change this practice. For example, the company could charge employees 0-5 percent of their salaries for insurance, depending upon what

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levels they choose and the number of family members they are covering. If employees choose the most basic level acceptable for only themselves, they might pay 0 percent. If they choose a platinum level plan for a family of four, they would pay 5 percent. Plans between these two ranges would be adjusted accordingly. Employees could then choose the plans that work best for themselves and their families at a cost that is appropriate for their income.

Organizations that demonstrate behavior in alignment with their mission gain the trust not only of consumer stakeholders, but of employees as well (Jiang, 2014, p. 493). Even if Cigna changed the benefits package and nothing else, it would send a strong message to workers that the organization is true to its mission in supporting employee health, well-being, and sense of security. More than that, employees will have had direct and positive experiences with the very service—health care insurance —that Cigna provides. They will share these experiences with friends, family, and customers as brand ambassadors, who have been shown to be able to have impact on other stakeholder groups (Varey 2013, p. 197). Workers that believe Cigna's mission is credible and are proud to work there awill impart positive feelings about their employer to customers and others, further improving reputation.

While reviews on Glassdoor.com reveal that Cigna provides substandard and expensive health benefits, salaries seem to be considered fair. Even so, it would behoove the company to improve its worker pay, particularly for customer-facing employees. This would help them to demonstrate good CSR, provide security to employees, and also help them attract and retain the best workers. Worker pay is considered an issue of social responsibility and is currently a salient media issue since states and the federal government are currently debating raising the minimum wage. Some organizations, like Costco, have long been lauded for providing above average wages. Other companies, like the Gap, have recently raised their minimum wage above federal guidelines (Greenhouse, 2014, para. 1). The reason the Gap gave for its increase was that the company has a more complex customer service model that requires the best talent, so the organization needed minimum pay to be above that of its competitors (para. 11-13). Likewise, if Cigna is to have the best customer service in the industry with representatives who can truly help customers solve problems in meaningful ways, compensation should match the expertise required. The company should review the wages of all its competitors, and pay its workers more to demonstrate the talent they have and want to attract.

Responsible Change Action 3: New Underwriting and Claims Processing Models The most damning complaints against Cigna are in the area of mismanaging and denying claims. Practices perceived as unethical have caused public embarrassment, expensive lawsuits, and untold reputational damage for the organization. Cigna should be the company that faces and changes this ethical problem, overhauling claim practices and influencing the negative perception that insurers regularly value profits over care. Insurance underwriting is a complex process, but Cigna's experts should form a company committee to review and completely update underwriting models and claim denial and appeal processes. While the final results will depend on the decisions of the experts, they should form their recommendations with Cigna's mission and the principle of leading responsibly as guiding forces.

Studies on branding by Seigel + Gale revealed that consumers strongly value companies that

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provide easy-to-understand products and services. They indexed companies accordingly and found Cigna among the lowest (Tuttle, 2013, para. 7). Many consumers complain that they don't understand Cigna's insurance plans or rules. While providing personalized online information and better trained customer service representatives will help, an effort to streamline and better communicate about products should be included in the underwriting and claims process review. If products are easier to understand and explain, it help customer-service employees more easily become subject experts who can better serve customers.

Next Steps Innovation need not be limited to the areas outlined in this document. Cigna could investigate other practices that would engage stakeholder groups and support its overall mission. For example, the ACA is hard for many individuals to understand and information is difficult to obtain, particularly in states headed by Republican leadership, some of which did not allocate funds for ACA communications. Cigna could use existing offices to provide free one-on-one ACA counseling.

Many other services along the lines of assisting consumers navigate the new health-care environment would further the organization’s reputation as a leader.

No matter which options Cigna ultimately chooses, it will first need to draft a strategic plan—or amend its current one—to enact these changes successfully. Individuals in the organization may not agree about the best ways to change policies and practices. A good strategic plan can be the guide, and it will be key that the plan have consensus among leadership and gain support before communicated to stakeholder groups (Kinzey. 2014). While the actions outlined here can help Cigna to enhance its reputation, the most efficient starting point is having a strategic plan in place from which all actions come and against which actions are measured.

Finally, Cigna will need a communications plan that stems from the strategic plan to publicize the changes it makes. Customers and employees will certainly communicate the organization's improvements via word-of-mouth, which will be quite powerful. However, it will also be important to strategically communicate to all stakeholder groups as well as prospective customers that Cigna is a leader in the industry for its new, care-centered approach.

Conclusion The Cigna Corporation is a leading health insurance organization, but it does not currently have the leading reputation. As it seeks to participate in a new—and more competitive—health-care environment, it faces great opportunity. However, the profits and increase in stock value it has seen as a result of new customers gained from the ACA will only be temporary if the organization does not improve its reputation. Most health-care organizations are continuing to operate by the same rules and socially irresponsible standards of the past, which do not generate consumer or employee trust. Cigna could take a leadership position and make substantive changes to benefit its employees and customers, and communicate about them in full-throated support of ethical care for stakeholders above shareholder profit. This would, in turn, generate trust and loyalty among consumers and employees, and in the long run, improve profits and long-term success in a changing marketplace.

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