Cigna’s Push to Lower Costs, Modernize Healthcare

Is Connecticut still the insurance capital of the world? The Cigna Group’s president and chief operating officer Brian Evanko certainly thinks so.  

Evanko spoke candidly about the U.S. healthcare market and Cigna’s footprint with CBIA president and CEO Chris DiPentima at CBIA’s 2026 Economic Summit + Outlook Jan. 29 in the capital city.   

“The number one thing we talk about is affordability,” Evanko said. “The affordability of healthcare across the country is a huge challenge.”  

He said the average total healthcare cost per person in the U.S.—including what’s paid by individuals, employers, and the government—was more than $15,000 last year.  

And it’s no surprise Connecticut is among the top 10 high cost states.  

But the 230-year-old company is committed to being part of the solution to lower costs—with some of that work beginning in Hartford.   

Affordability Challenges  

Hartford was among a handful of focus markets where Cigna launched its Health Equity Impact Fund initiative, which partners with nonprofits to improve access to care by deploying mobile clinics in communities where it is difficult for people to find transportation to a doctor’s office.  

While Evanko expressed optimism about the future of healthcare—with partners committed to collaboration—he warned 2026 will likely mark a third-straight year of high single- and low double-digit increases.  

Evanko believes part of the affordability challenge in healthcare is the divergence of supply and demand.  

With an aging population, an increase in chronic diseases, and a culture of guaranteed access, there is strong demand in the U.S. for healthcare. 

While prescription drugs have been one of the greatest modern innovations, Evanko said the median price of a new drug was $370,000 last year, with research and development efforts targeting rarer, more complex medical conditions.  

Amid new medical technology costs and providers grappling with wage inflation, real estate costs, and energy cost spikes, challenges persist.   

And supply in healthcare does not relieve pressure the same way it does in other sectors.  

“So we’ve got a demand challenge, where there’s more and more need, and we’ve got a supply problem, because the unit pricing continues to develop in healthcare so that’s a real problem,” Evanko said.  

Bending the Cost Curve  

Evanko said there are opportunities to bring down costs, but alluded to the fact that it will take time and a shift in individual behaviors.  

For starters, he said the U.S. has some of the best generic drug pricing in the world. And while 90% of all prescriptions are generics, brand-name drugs—10% of prescriptions—represent 88% of dollars spent.  

Part of the company’s focus is how to move patients who are using an expensive brand, but can be on a clinically equivalent generic.  

“It saves a ton of money for the employer and saves a ton of money for the patient, because oftentimes it’s $0 out of pocket or a low copay for generics.” 

Connecticut ranks among the top three states for state-mandated health benefits, adding more than $2,000 to the cost of health insurance premiums in Connecticut. https://t.co/AN96fmaRKL#healthcare #Connecticut #affordability

— CBIA (@CBIANews) January 27, 2026

A similar change in mindset is already taking place when it comes to elective surgeries.  

Before the pandemic, about 80% of elective surgeries were performed in hospitals with an overnight stay. Now 80% are performed outside hospitals.

“It hasn’t been enough to defray the affordability challenges I made reference to, but it’s a success story of moving to a lower acuity and lower cost site of care,” Evanko said.  

“And we’re seeking to do more of that with other examples in terms of how do you get to a patient at the right time, to help educate them and engage with them to make the right choice on their healthcare decision.”  

Reducing Inefficiencies  

Conversations around advancing healthcare systematically often include a disussion about advancing technology in the space.  

“The system is fragmented and it’s complicated and there’s not one player that can solve everything,” Evanko said.  

One example—physicians around the country have varying levels of digital maturity.  

“So over time, we see a great opportunity to move the entire system to a much more digitized, technologically-enabled, AI-powered world.”

Cigna’s Brian Evanko

Evanko said the main communication with many doctors’ offices remains through fax.  

“So over time, we see a great opportunity to move the entire system to a much more digitized, technologically-enabled, AI-powered world, which can help with some of that, because it infuses information at the right time for the right patient,” Evanko said. 

He also sees opportunities to digitize how healthcare professionals interact and engage with pharmacies, employers, employees, and their family members.  

“We see technology as a critical unlock to improving the healthcare system in the future.” 

Framework for Innovation 

Improving affordability and accelerating technology adoption begins with innovation. 

For a company with roots as deep as Cigna’s and with 60,000 employees globally, that requires intention and structure.  

Evanko said the company must design for innovation.  

“The people running the trains are probably not going to be the same people that are going to be the innovators,” Evanko said.  

“It’s really hard to say, keep running the trains and design the bullet train that’s going to run alongside that.” 

“The people running the trains are probably not going to be the same people that are going to be the innovators.”  

Evanko

That’s why Cigna creates structural separation, carving out teams with dedicated capital, talent, and problem statements, to drive innovation.  

“The key thing, though, with that is they need to have the right business context,” Evanko said. “So you need to have some bidirectional business experts, with the innovators working constructively together.” 

Evanko noted that the company overhauled its pharmacy benefits program thanks to that kind of team.  

“That was an innovation that actually shocked a lot of the market,” he explained.  

“Our stock went down when we introduced it, but we said, ‘it’s the right thing to do to make the company sustainable for the next 10 to 20, years, and make sure that the patient feels like we’re on their side.’” 

Navigating Uncertainty  

With eyes on the future, Evanko said Cigna is no stranger to the pressures employers face today—from inflation and energy costs to global and domestic policy shifts. 

“It’s a really challenging time environmentally,” he said. “So there’s the lack of predictability, there’s affordability pressures, not just in healthcare.” 

Evanko outlined three focus areas for him as a leader, beginning with the importance of shared context. 

“It’s a really challenging time environmentally. So there’s the lack of predictability, there’s affordability pressures, not just in healthcare.

Evanko

Whether with employees, customers, or community partners, he said business leaders need to create a common foundation of facts and expectations.  

He also underscored developing the workforce—through training and upskilling—to keep pace with rapid change.

Finally, Evanko highlighted a major shift in how Cigna approaches long-term planning, moving toward a scenario-based model to prepare for differing futures.  

“We’re saying which of our actions are impervious to the scenario versus which ones are actually path dependent,” he said. 

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The Economic Summit + Outlook 2026 was made possible through the generous support of Webster Bank, with additional support from Bradley International Airport, PwC, Cigna, DoorDash, Eversource Energy, and Kamco.