Will Post-Brian Thompson Reforms Go the Way of DEI?

What happens when violent events amplify calls for reform?

Let’s take a trip back in time.

It’s the pandemic, May 25, 2020. George Floyd is murdered on the sidewalk in broad daylight by Minneapolis PD, led by Derek Chauvin. Floyd’s murder “triggered a reckoning on race and policing” with calls for reform ranging from defunding the police to White Privilege book clubs to the strengthening of the Black Lives Matter movement.

Fast forward, December 4, 2024. UnitedHealthcare CEO Brian Thompson is also murdered on a sidewalk in broad daylight, this time in Manhattan. Accused assailant Luigi Mangione is in custody, with an evidence trail that includes his manifesto and shell casings inscribed with “Deny,” “Defend,” “Depose”.

What do these events have in common? A violent event that fixed a razor-sharp spotlight on the need for systemic solutions to painful, long-standing problems.

A reckoning

It was well-known, long before the pandemic, that 80% of healthcare outcomes are based on social drivers. It is also well-known that U.S. healthcare is a profit-driven, patchwork system in desperate need of reform. These reforms must answer key questions: How can healthcare be accessible, affordable, and equitable while leading to better outcomes?

Though these questions have never stopped, they’ve been swirling anew for more than a quarter now, the unit of time the market uses to measure value. The preference for short-term ROI over long-term investment and solutions begs another question: 

Will post-Brian Thompson proposals last or will they suffer the fate of another call for change instigated by violence: the once-amplified, now-waning commitment to Diversity, Equity and Inclusion (DEI) following the death of George Floyd.

The question might suggest that healthcare reform is also waning. Far from it. But what’s next? How can the nature of systems change help us predict it?

Health plans respond to the death of one of their own

Thompson’s murder has sparked significant discussion on how to solve the industry’s systemic challenges. Proposals range from eliminating employer-sponsored insurance (Oscar Health CEO Mark Bertolini) to curbing one of healthcare’s biggest hobgoblins: prior authorization (PA).

The first reform came the day after Thompson’s murder. Facing backlash, Anthem Blue Cross Blue Shield reversed a policy that would have limited anesthesia coverage based on arbitrary time limits.

Two other health plan responses are noteworthy: those of UnitedHealth Group, the parent company of UnitedHealthcare, and The Cigna Group.

UnitedHealth Group: “The health care system is flawed. Let’s fix it.”

UnitedHealth Group CEO Andrew Witty acknowledged public outrage with America’s broken healthcare system in a Dec. 13, 2024, op-ed in The New York Times.

“[T]the health system does not work as well as it should, and we understand people's frustrations with it. No one would design a system like the one we have. And no one did. It's a patchwork built over decades."

Witty expanded on these comments in the company’s Q4 2024 earnings call, noting that there are “so many areas that can be enhanced, reworked, reengineered, or even scrapped to make the health system work better.” He highlighted three:

• Enhancing and standardizing AI/digital tools to improve healthcare navigation, data collection, and value-based care (VBC) delivery
• Ensuring 100% pass-through of PBM rebate discounts to health plan members
• Speeding up approvals “to materially reduce the overall number of prior authorizations used for certain Medicare Advantage services”

A Forbes contributor piece has called for United to compete “on health, not denials” and to “lead the future of healthcare” in three areas:

1. Capitated (“fixed”) provider payments
2. Primary and preventive care
3. Advanced chronic disease management through generative AI

One of UnitedHealth Group's most recent reforms is to end PA requirements for home health services managed by Home & Community, a post-acute healthcare services company owned by its Optum business. The change applies to MA and Dual Special Needs Plans (D-SNP) in 36 states and the District of Columbia and became effective Apr. 1, 2025.

The Cigna Group: “We owe it to our customers to make the health care system work better”

After Thompson’s murder, The Cigna Group was the first health insurer to announce detailed reforms — a multi-year commitment focused on five areas, some of which build on existing initiatives:

1. Easier Access to Care: Making customer processes “simpler, easier and faster.” PA is one of these process categories. Here, Cigna is “accelerating and simplifying” provider claim and PA requests by expanding digital options that help ensure completeness and accuracy at point of submission. Noting that "more can be done to reduce the administrative burden on clinicians,” a Cigna representative added that PA “is required for less than 4% of services for Cigna Healthcare customers” and that the company “has removed the prior authorization requirement for about 1,100 services and devices” since 2020.
2. Delivering Better Value: Making prescription drug costs more predictable and implementing more tools to resolve claims/PA challenges. Examples include enhancing existing digital status trackers and — per a Cigna media representative — engaging with clinicians “to align on care delivery goals and outcomes and continue to evaluate whether there are other changes we can make without compromising patient safety.”
3. Better Support: Doubling the number of My Personal Champions, who help customers with more complex needs navigate the healthcare system.
4. Accountability: Implementing “governance processes at the highest levels to successfully ensure positive changes.” This will include tying leadership compensation to customer satisfaction and creating a new Office of Excellence and Transformation (OET).
5. Transparency: Sharing how The Cigna Group “is continuously improving” via an annual Customer Transparency Report.

Cigna has announced what appears to be the most detailed public reform plan so far: “Let’s Make It Better”^SM. Its goal is to regain trust “through the results people will see” per Dr. David Brailer, Cigna Health Group’s EVP and Chief Health Officer, who will oversee the OET.

Cigna should be commended. If reform efforts aren’t met with optimism — albeit cautious and supported with results — they will be undermined by cynicism. When asked ‘Why now?’ on its reforms, a Cigna representative noted that CEO David Cordani’s had addressed this question on the company’s Q4 2024 earnings call:

“In early December, we were all witnesses to the tragic murder of Brian Thompson, a leader at the UnitedHealth Group. The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry. At the Cigna Group, we are further accelerating improvements in innovations to increase transparency, expand support and drive even greater accountability.”

This returns us to the original question. Will commitments to post-Brian Thompson reforms persist? Or will they go the way of other reforms instigated by tragedy?