CVS Health's health benefits arm, Aetna, is using artificial intelligence in its new Care Paths program that connects members with diabetes, joint health and maternity needs to a personalized view of their benefits.
Available through the Aetna Health app, Care Paths aims to provide clarity about procedures and benefits, as well as personalized care recommendations. The patent is still pending on the technology, CVS said.
In addition to a more personalized view of relevant benefit information, the technology connects members to a care team, as well as wellness programs tailored to their specific condition, plus opportunities to order care kits for additional support.
"Aetna Care Paths are one example of CVS Health's $20 billion multiyear digital investment in making healthcare simpler to navigate, a key aspect of Aetna's strategy of leveraging technology to deliver a better experience for our members and providers," said Nathan Frank, senior vice president and chief digital and technology officer at Aetna. "Leading-edge digital tools, including AI, support members at every stage of their health journey."
WHAT'S THE IMPACT
Aetna has made a number of other updates to the Aetna Health app, including vaccine scheduling, whereby members can view and schedule recommended vaccines through their local CVS Pharmacy and MinuteClinic.
By the end of this month, members will find the chat icon on the home screen and core landing pages. This AI-powered chat provides immediate answers and integrates with Aetna's call centers if a human touch is needed, the company said.
The Smart Compare feature uses intelligent matching to offer members personalized provider recommendations, while a new "donut" chart clearly breaks down claim costs in a more visually clear manner.
Aetna also touted the app's low-light dark mode interface, which it said improves accessibility and provides a more comfortable view for people who prefer a darker display. It's a first-of-its-kind feature among health insurance apps, said Aetna.
"We're giving our nurses more quality time to connect with members, listen to their concerns and help them navigate their health journeys," said Dr. Ben Kornitzer, Aetna's chief medical officer. "This could be a cancer patient, or a member recently diagnosed with heart disease, and that extra time in one-on-one conversations, not only improves physical health outcomes, but also supports our member's mental well-being."
THE LARGER TREND
During CVS Health's Q1 earnings call in May, Aetna revealed it would be exiting the Affordable Care Act individual markets in 2026.
Aetna has exited the ACA market before, in 2018, when it joined other insurers in leaving or downsizing its footprint, as premiums rose and insurers lost money.
In 2021, Aetna reentered the market, and former CEO Karen Lynch said at the time that the market had stabilized and resolved earlier "structural issues."
Yet Aetna has struggled since its reintroduction into the ACA exchange and posted an adjusted operating income loss of $924 million in 2024.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.