'We have a great boat' in 'choppy waters'

Steve Nelson, President, Aetna, explains how they’re steadying the ride for members and why affordability is about more than one fix.

• Aetna is empowering its members with clearer choices, better tools and improved navigation to help lower the total cost of care, Steve says.

• To deliver health care that feels more personalized, intuitive and easy to navigate, Aetna is borrowing from the best consumer experiences, including Spotify, Delta, Peloton and even Diet Coke.

• “The future is very bright. I'm very excited,” Steve says. “I've seen more progress in the last 18 months than I've seen in the last decade of my career.”

Creators and Guests

Host

Matt McGuire

A lifelong writer, editor and content strategist. Senior Manager, Enterprise Communications, CVS Health

What is Big Questions Answered?

Big Questions Answered helps us understand important CVS Health initiatives by taking a closer look at new products, powerful innovations and the big changes the company is making to achieve its strategic imperatives and build a world of health around every consumer. The company's senior leaders answer big questions from host Matt McGuire.

Matt McGuire
Over the past year and a half, Aetna has reset its trajectory with a clear focus on excelling at the fundamentals, being truly distinctive and building a winning culture. This pivot has re energized colleagues, strengthened trust and created new momentum across the business.

As part of this shift, Aetna is taking on one of the biggest challenges in health care: affordability. It’s doing this by making the system easier to navigate and giving members guidance and support as they make health care decisions.

On this episode of Big Questions Answered we’ll explore how tools like Care Paths and the Aetna Health app are making health care easier to understand and navigate for members. We’ll learn what’s behind Aetna’s efforts to streamline prior authorizations and why it matters for faster, simpler access to care. And we’ll find out why deeper partnerships with providers are essential to delivering better care at a lower total cost.

Welcome to Big Questions Answered, a podcast that helps us understand the important initiatives at CVS Health. I’m Matt McGuire from the Enterprise Communications team. I’ll be your host as we dive into the latest developments, breakthroughs and innovations that are helping us achieve our ambition to become America’s most trusted health care company. Thanks for joining me today as we get our big questions answered.

Steve Nelson is our guest this month. He's the President of Aetna and Executive Vice President at CVS Health. In this capacity, he oversees Aetna's Commercial and Specialty markets, and Medicare and Medicaid businesses, with the goal of delivering affordable, simple, and personalized experience for our members and customers.

Steve shapes Aetna's strategy, with a focus on excelling at the fundamentals, being truly distinctive and fostering a winning culture across the enterprise.

Steve, thanks for stopping by today.

Steve Nelson
Thanks, Matt. It's an honor to be here and excited to have the conversation.

Matt McGuire
So, Steve, you've been the president of Aetna for the last year and a half, a period of unprecedented change in the health care industry and at Aetna. As you look back, what are some of the key initiatives that helped Aetna adapt, innovate and deliver meaningful improvements for its members?

Steve Nelson
Yeah, it's been, I'd say, a pretty adventurous and impactful 18 months. I'm always up for an adventure and this has certainly been one. The intensity around health care in in my, I don't know, 37-38 years of doing this has been really high and kind of unprecedented. And that comes with a lot of challenges, for sure. We've had historically high health care costs. So, the trends have been high, and that by itself creates frustration.

In addition to that, we have consumer expectations that have really changed, driven by other industries, but also frustration with their inability to easily navigate health care. And then there's, just to be really candid about it, there's been a lot of finger pointing. You know, like, OK, it's the insurance company's fault. No, it's the pharmacy's fault. No, it's the hospital's fault. It's the doctor’s, it's CMS. It just hasn't been a constructive and healthy, my opinion, dialogue. And it's it just it feels like everything's ramped up, you know, in general. And not a constructive way.

And so, when you put all that together, and then you go back two years ago where Aetna was in terms of our performance, both externally and internally, just the sentiment amongst our colleagues, it was kind of a low point. And I would say in the fall of 2024, specifically November 21, we had a town hall, and I stood on stage and I said, “Let's let today be a pivot.” That's changed the trajectory of how we think, our ability to, impact how we work together, how we think about being part of CVS Health and the role that we can play in the U.S. health care system.

The way that our company and our colleagues responded, it just it absolutely blew me away. And I don't think I've ever seen anything quite like the response to that challenge. In this past 18 months, I would say, it's been some of the most fulfilling sort of months of my entire career because of that.

And so when you think about sort of how this all happened, I think it starts with a set of very clear priorities. You said them at the at the top there, Matt, where we said we are going to be exceptional to fundamentals, we're going to be truly distinctive and we're going to build a winning culture. And people have embraced that. And it's not just banners, you know, in an auditorium, but it's throughout the organization. Wherever I go people are talking about this and how they're how they've adopted that agenda as their own. And it's very connected to the work that we're doing. So, all in all, the challenges that we've seen, the intensity that we've seen, has created opportunities, and our organization has embraced those challenges. And I've seen our colleagues step up in a way that is just absolutely incredible.

Matt McGuire
I remember that Town Hall. And, yeah, you’re absolutely right, our colleagues have really embraced that idea of pivoting and becoming even more exceptional and distinctive. So, you’ve talked about pivoting. You’ve also talked about today’s health care marketplace. You’ve described it as being filled with “choppy waters.” And as we all continue to navigate that uncertainty, affordability remains is one of the biggest concerns for patients. What are some of the ways Aetna is addressing that challenge for its members?

Steve Nelson
Choppy waters is an analogy that that I've used, and I think it's still a true statement. Choppy waters is a way to think about the environment that we're in. And I use the word choppy or that phrase, that analogy, because there's a lot coming at us from all different directions — from our providers, from our customers, from our stakeholders that are investors are, you know, each other. We're all health care consumers, you know, and we're frustrated. It's hard to navigate. It's expensive. And then we have regulators. The majority of the revenue that Aetna brings in is from actually the federal and state governments. And so you know that that sets us up to be very much in in the limelight, as they say. And our government partners have a lot to say and a big voice. And so, choppy waters, for sure. And for the reasons I talked about earlier.

The thing that I've been excited about is, kind of continue with the choppy waters analogy that, we have a great boat, you know, and that boat is Aetna. We have incredible tools to navigate and, I'll talk about that more in a minute. But we have a great crew, we have incredible leaders. We've put together a leadership team that I think is the best in in the industry. And the crew extends to all of our colleagues. And look, I think we're very capable and we have a lot of opportunities to navigate the choppy waters better than others. And I think that's actually been proven as we look at the external accolades and acknowledgments that we've had where people said, “Hey, Aetna, you guys are leading.” We were awarded the Press Ganey Health Plan of the Year award objective based on as a CEO, Press Ganey says based on math. You know just the data supports that that Aetna is leading. We've had many other publications and other organizations that, through their objective process, that Aetna is leading. So, it's not just us saying that, you know, it's the external stakeholders and our clients.

And, so, we've seen some unprecedented growth in our commercial business, for example. We've advanced our Medicare business in a meaningful way. Our Medicaid businesses is on very solid footing. And we are serving folks in a better than we've ever served them before. So, the focus on the experience, the focus on navigation, advocacy and better partnerships with our providers, that all plays into this idea of the total cost of care and affordability.

We have something like 2,000 initiatives lined up against trend, specifically. What's interesting is we're not going to really solve the health care affordability issue unless we can lean more into navigation and better partnerships with providers. We're not going to change the trajectory and the health care trend by doing the same things that we've always done. And so that's why I'm really excited about as you think about the future and where we're going and our opportunity to lead, navigation, empowering our consumers to make better choices, be better consumers of health care. You know, those are the kinds of things that are going to sort of reshape our industry and actually bring down total cost of care.

Matt McGuire
I love the idea of empowering members to make better choices. I know Aetna is giving them more opportunities to do this. And this ties in nicely with improving the member experience. What are some of the more meaningful ways Aetna has been improving the experience for members recently?

Steve Nelson
You know it's at the forefront of our minds, and everything we do is focused on trying to create a different experience, which will result in, I think, lower health care costs and better outcomes, so that's got to be at the front. And so, a couple examples how we've done that.

Prior authorization has been at the focus of a lot of conversations. It plays an important role, but we need to simplify, streamline and create more transparency. And so, we've done that in a variety of ways. One is we've reduced the volume of prior authorizations. But the good news is Aetna actually started relative to the industry with some of the lowest number of prior authorizations required, so that's a great starting point, but we've even reduced that and streamlined the process. So, one example is if you have a complex diagnosis, previously you've had to get prior authorization for every single component of your care. Now we've bundled them together, so you need one prior authorization for everything that that you have, whether it's imaging or medications or procedures.

Second, we've created more transparency, so you know where you are in the process. Our digital tools on the Aetna Health app has been, you know, dramatically improved and we've created a lot of tools for folks. And then we've also introduced things like Care Pathways, which is a way that people can take their health care journey to this digital tool and get some coaching. And then if they really need it, we also have humans, you know, standing by to help you navigate our advocates. And so, it's been a really meaningful advancement in the experience and I think again that's going to lead to ultimately lower health care costs because people are going to be smarter consumers, and I think, you know, that's the future.

Matt McGuire
So, speaking of new digital tools like Care Paths and the Aetna Health app, how are these changes making health care easier to navigate for members?

Steve Nelson
I think it's doing it in several ways. One is you have more information at your fingertips. Now, one of the things that's been frustrating is we've been inundated with information, but it makes it digestible and consumable, and it's personalized to you and your experience.
And we know a lot about you as a health care consumer, and we can put that data to good use. Not in a way that makes people feel like we’re violating their privacy, but it's consistent with other consumer experiences we have — think Spotify or Peloton or, you know, some of these other places were like, “Hey, we know what you've done this this year. We know how you've how you've listened to music or how you've used your Peloton bike or whatever it is. And we're going to help give you some suggestions based on that and based on your goals. And we can do that in health care now, too.” And I think, you know, that's exciting and so Care Pathways is one example, but there are many examples where we are now using AI, so we can personalize more effectively, and we can actually synthesize and aggregate and kind of make sense out of the data for you, and then give it to you in a way where you have both choice and options, and you feel like you are in control of your own health care journey.

Matt McGuire
That's great. So, switching gears a little bit. We've been talking about members a lot. Let's talk about providers for a second. So, Aetna works with well over a million health care providers nationwide, and we recently surveyed them about their experience working with Aetna. What are some of the insights that are emerging from those survey results?

Steve Nelson
Well, as I said earlier, you know, we have three themes that we're following that we think will help us to become truly distinctive: better navigation, more advocacy and then provider-payor partnerships. And this last one is we're really leaning in. And I have had the opportunity to lead provider organizations and peer organizations, so I've sat in both chairs. And I think I can speak with some credibility that we are all trying to do the same thing. You know, we are trying to create better experiences, better outcomes, better processes and lower cost frankly for the delivery of care for our patients and our members.

The tension and the sort of distrust between those two parties is real. It's something that we need to kind of face head on. So, the provider survey is one way of us getting after the truth, if you will. And I say, I like to say, you know, hey, feedback is a gift, even though sometimes it's painful. We wanted to understand how do they think about not just Aetna, but about peers in general. And so we got some good feedback.

Look, they are optimistic. You know, they think that eventually AI and other tools will help. But right now trust is lower than we'd like it to be. They are kind of suspicious of our motives, if you will, and they don't think we're focused on the right things. And so we have an opportunity to, I think, use that information and change the dialogue. And where we have done that, we have seen real results. And we're doing that across the country. And it's hard to talk to a million providers, but we are talking to large organizations, academic, not-for-profit, public traded physician groups, a variety. And so we're getting some great insights. And when we have changed the dialogue, we're seeing improvement in not only the relationship, but how patients experience the system. And it actually, again, results in a lower total cost of care and better outcomes. So, I'm very optimistic that this is this going to be a signature of Aetna in the U.S. health care system where we are the best payor for providers to work with.

Matt McGuire
So, looking ahead to the rest of 2026 and into 2027, what's next for Aetna as you continue evolving the care models for members?

Steve Nelson
So, our vision is a continuation of where we started — excelling at the fundamentals, being truly distinctive and building a winning culture. So, we're going to continue to be focused on those three things. But the agenda gets bolder and more ambitious as we go along because we now have the foundation in place. We have incredible people, we have the right leadership team, we have a winning culture and we have a distinction agenda. And now it's about executing and really building that out. So, when I talk about navigation, some of the opportunities there, we are going beyond what we see in health care and going to other industries and think about the experiences you have with some of the leading consumer products, whether it's Apple or a service industry like Delta Airlines or a product that you love like I love Diet Coke.

And, so, what is distinctive about those experiences and products — and the example I used about Spotify — we are learning from other industries and other consumer experiences, and we're going to bring that to health care. Health care has lagged behind, so we are going to not only get to a different level within health care, but we're going to jump ahead and go to the sort of next level and move from a transaction orientation to a consumer solutions orientation. And we have the opportunity, especially as part of the CVS Health. Think about all the consumer touch points that we have with the retail pharmacies, for example, we can use those insights and leverage that. And so I think the future is very bright. I'm very excited. I've seen more progress in the last 18 months than I've seen in the last decade of my career. And, so, we're going to continue to accelerate things and using all the tools that we have, and very excited about the role that AI can play in this to help us shape the future. But it's really going to be built on that foundation of better navigation, advocacy and partnerships with providers.

Matt McGuire
Steve, I've been looking forward to this conversation for a while. I’ve had a great time talking with you today. Thank you very much for stopping by.

Steve Nelson
Great. Thank you, Matt. It's been a pleasure and appreciate the opportunity.

Matt McGuire
And a big thanks to you for tuning in to this episode. Until next time, I'm Matt McGuire. I look forward to joining you again to get more big questions answered.