Earlier this year, CVS Health announced that it would invest $20 billion in improving the consumer experience and making the healthcare journey simpler.
Now, its health benefits arm, Aetna, is unveiling its new Care Paths program, which connects members who have certain health needs—launching with diabetes, joint health and maternity care—to a more personalized view of their benefits and more directly with the care team supporting them. The platform is powered by artificial intelligence and offers users individualized recommendations for health and wellness programs related to their conditions as well as care kits when available.
The goal, the insurer said, is to make members' interactions with their health plans feel less transactional and instead more holistic. Aetna offered an exclusive look at the new offering to Fierce Healthcare.
Nathan Frank, senior vice president and chief digital and technology officer at Aetna, told Fierce that the healthcare system often puts the onus on the patient to reach out first and make contact, which can be confusing, frustrating and overwhelming.
"We're transitioning from relying on the customer to engage with us to more customer advocacy by getting in touch with them, being proactive and predictive, by using all the information that we have," Frank said.
Frank said the Care Paths program also offers more transparency around prior authorization requests and where those submissions stand. He said Aetna has a patent pending on the new engine to make program recommendations.
He added that early feedback on the platform has been "powerful," as members feel more connected to their coverage and the care team backing them up.
"One of the quotes was, 'We actually believe you want us to use the benefit. You're making it easy for us to use them,'" he said.
While Care Paths is launching initially in three focus areas, the development team is building out a road map for the future and intends to continue expanding to other conditions down the line. And member feedback is driving those conversations, for example, recommending cardiovascular needs or offerings in oncology.
That allows the team to prioritize next steps based on what members want and need the most, Frank said.
Aetna said close to half of its active members interact with its app each month, looking for additional details about their benefits and to find in-network providers. The team is aiming for that experience to seamlessly connect users to the information they need, including the new Care Paths.
The insurer has also added in a tool that helps users better connect to providers who are accepting new patients by leveraging its claims data for insights beyond what providers themselves disclose. Members can also use a new cost tracking feature that makes it simpler for them to monitor both in-network and out-of-network spending, deductibles and any claims associated with their expenses.
Frank added that intelligent provider matching tools can also surface recommendations about which clinicians may meet patients' language preferences or are within a certain location.
In addition, members can submit bills digitally by taking a photo of the provider's billing statements, which AI can then match to existing claims, offering greater clarity around their likely out-of-pocket costs.
"We don't want to just kind of make it incrementally easier," Frank said. "We want to change the way that our members interact with us through our digital experiences."