During the last few years health insurance companies have shifted from an employer-focused mindset to one that is increasingly consumer-, member-, or individual-focused. The move toward consumer engagement, Cigna's Director of IT Strategy and Innovation Willis Gee told MobiHealthNews, is being driven by cost and quality pressures, new benefits models and growing information intensity.

Nearly all health plans and payors these days point to some permutation of a "triple aim" of affordability, satisfaction, and quality as their mandates. For its part, Cigna says it is looking outside the healthcare industry to take cues from leading consumer companies like Amazon, eBay, and Bank of America, as it continues to develop its consumer engagement strategy to help it achieve those aims.

At the core of Cigna's strategy is what the company internally refers to as its "Know Me Engine", which is made up of all the various ways the company collects data on its members, including data from traditional sources like health claims and lab data but also newer sources like answers to gamified health risk assessments or data collected by what Gee calls "instrumentation devices", or what are popularly referred to as quantified self tools.

The Know Me Engine "is our way of building a platform that takes into consideration the likes, preferences, and dislikes that a member has, which we then wrap around a platform we call 'Health View', our longitudinal view of a member that takes into consideration all of our interactions with them, all of the data we collect, so that we can personalize the experience for that individual."

"Ultimately, it is about meeting customers where they are," Gee said. "That is where we are starting to see the intersection between mobile, gamification -- which is becoming an increasingly interesting area for us -- social media, and big data -- another buzz word you are starting to see a lot more."

Mobile is very important to Cigna's consumer engagement strategy, Gee said, after pointing out that there are now more mobile phones in the US than there are people. He also noted that there will be more internet searches conducted from mobile devices in two to three years than from desktops. Cigna has taken many of its digital assets mobile, including its provider director, health risk assessments, and even some telehealth services are moving to the company's mobile apps.

The myCigna app for Android and iOS users includes a laundry list of features, like personalized benefits information, personalized claims, provider directory, cost and quality tools that cover hospitals, physicians, and drug comparisons. Gee characterizes those as some of the core customer services capabilities. Beyond that Cigna is beginning to extend some consumer decision support and condition management tools to its mobile app.

One example, Gee said, was its gamified health risk assessment that the company partnered with Audax Health to develop.

"We took a rather mundane task of a health risk assessment and we're asking questions in a different way," he said. "Historically, you'd go through a survey of 60 questions about your health. With this tool you go through a very slimmed down list of questions like: What would you rather eat: A slice of pizza or a salad? Would you prefer to take a nap or prefer to take a run? These tease out information about that person to create an online profile for them, which then allows us to really target what personal goals and objectives they have."

Members who take the HSA then receive incentives that they can redeem as rewards for positive health behaviors -- all through the mobile platform, Gee said, which is rare for health risk assessments.

"The other technology we are starting to introduce within our mobile platform is telehealth," Gee said, alluding to Cigna's recent deal with MDLive. "Video conferencing, click to chat, click to email, are capabilities we are building out in the very near future. People check their cell phones 100 to 150 times per day. For us, mobile is where we need to thrive."

Another key area of focus for Cigna's consumer engagement strategy is gamification.

"Historically, healthcare, has not been leveraging games to engage customers," Gee said, "but look at how ubiquitous it is, something like 70 percent of mobile phone owners are playing games on them. Just look at how many of our households have game consoles in them. [Gaming] is a way that we can reach people in a unique way that really starts to integrate and become a part of their daily life, which is ultimately what we need to do."

Gee pointed to Cigna's longtime work on healthy gaming with Hope Lab, where it has helped to develop games for people with cancer and the exergaming system Zamzee, which is fighting childhood obesity and inactivity.

When it comes to social networking, Gee said Cigna mostly uses the big channels like other consumer-facing brands: "cautiously". Facebook and Twitter are great channels to connect with members to mostly learn about ways they could improve their products and better understand how their customer service is faring. Gee said Cigna is looking for ways to leverage social networks that are "not intrusive and, for lack of a better term, not creepy."

More intimate and focused social networks, like the ones Cigna and BodyMedia are creating for people managing diabetes, seem to have more promise. Gee confirmed that the pilot, which was announced before BodyMedia's acquisition by Jawbone earlier this year, is still underway. Cigna is developing infrastructure that Gee says will be device agnostic so that its members are able to use any tracking devices they choose, but also to keep up with what the company realizes is an ever-changing quantified self device landscape.

Tracking devices are an important part of Cigna's social network strategy but also its big data plans, according to Gee.

"With big data, I think the technology itself is important," Gee said, "but as we start to take data from a variety of sources whether through structured or unstructured data -- information from personal instrumentation devices, like a Fitbit or Nike+ FuelBand -- that's where we can start to get a lot more insight about our customers." Gee said this data could "ultimately redefine their customer service experience and also redefine their care process."

These devices, of course, can also enable telehealth services: "This is a very exciting space when you think about the sleep monitor devices, activity and fitness devices, and even something like pulse oximetry," Gee said. "Just think about someone with COPD who can use that device to collect their pulse ox, have it connect to their smartphone and send that to their physician to have them view it remotely. That, to me, is the future of where we are bringing the ICU to the member and not the other way around."

All of these tools and devices are "interesting", Gee said, but they become "extremely relevant" when you integrate them into a care plan and they begin to inform providers. That deeper integration is the next phase of development for Cigna's consumer engagement strategy. In the meantime, the company is also looking to work with or learn from digital health companies that "have a unique way of engaging customers," Gee said. Healthcare consumers can not be approached with a one-size-fits-all strategy, he said, and Cigna wants to talk to companies who have successfully found ways to engage patients of different ages, from different cultures, and with different health issues.