Aetna’s Nathan Frank on Scaling AI to Give Healthcare Workers Time Back

0:00Again, it's about building that trust. They know it's the Aetna digital experience that they use in the app. They see it in their text channel, and they're more likely to engage and interact with it.

0:14Peter High: Welcome to Technovation. I'm Peter High, president of Metastrategy. My guest today is Nathan Frank. Nathan is the senior vice president and chief digital and technology officer of Aetna, a CVS health company. CVS Health is one of the nation's largest healthcare organizations, generating nearly$390 billion in annual revenue. Aetna is one of the country's leading health insurers, providing medical, pharmacy, dental, behavioral health, and related benefits to approximately 27 million members. As the Chief Digital and Technology Officer, Nathan leads a team of approximately 6 ,000 professionals responsible for the digital platforms and experiences that serve Aetna's members, providers, and colleagues.

0:52Peter High: His team is focused on reducing friction across the healthcare journey, making it easier for consumers to navigate an often complex healthcare system while using data, AI, and digital technologies to improve transparency, lower the cost of care, and ultimately deliver better health outcomes. In today's conversation, we'll explore how Aetna is redesigning healthcare around the consumer, the role AI will play in transforming the member and provider experience, and what it takes to lead technology and innovation in one of the world's most complex industries, among other topics we'll cover. Nathan, welcome to Technovation.

1:24Peter High: It's great to speak with you today. Hey, Peter. Thanks for having me. I'm excited to be here. Today's episode is brought to you by Eleven Labs. Most enterprises trying to deploy AI agents hit the same wall. The agent itself is fine. The problem is that it sounds wrong. Robotic, flat, off-brand, and the moment a customer notices, the trust is gone. Eleven Labs develops the AI voice and audio models that give agents a human-level voice, the tone, the emotion, the rhythm of real speech, and wraps them in the full stack you need to actually deploy. Knowledge integrations, workflow tooling, multilingual support, and enterprise-grade reliability.

2:01Peter High: Build human-level conversational experiences into your products, services, and operations. Head to 11labs.io backslash technovation to get started for free. And now on to the interview. Yeah, I'm excited for our conversation. Take a moment, if you would, and talk a bit about Aetna, the business that you help lead, and its role in the broader CVS health portfolio, if you will. Sure, no problem. So most people experience health care through a series of disconnected moments, thinking about going to your doctor, visit, maybe going to the pharmacy, then calling your insurance company somewhere else.

2:43We have an integrated model here at CVS Health, and Aetna helps people connect with their coverage, pharmacy, and get better care and provide a seamless experience for all the members that we serve. CVS has four primary businesses. So think about the CVS pharmacy that you know, our Caremark PBM. We have a health care delivery unit. And then obviously our Aetna business that serves over 25 million members across our commercial Medicare and Medicare segments. We also have a dental vision and supplemental business that we serve millions more. we are focused on removing the friction in healthcare.

3:31If I could just get one thing across today, we know that healthcare is complex. We know there's friction. We want to increase the transparency. And we think that using technology to make it simpler for our members and have more connected experiences, and we know that provides better outcomes in healthcare.

3:55Peter High: Well, I'm looking forward to double-clicking on a few things you said there, certainly, Nathan, really interesting. Before I do, though, I'd love to have just as another context setting, talk a bit about your role as Chief Digital and Technology Officer of EDNA. Sure. I've been at CVS Health for a little over 13 years. I've spent time at our Caremark PBM leading technology there, as well as our CVS Health Enterprise, where I led our enterprise cloud strategy. I was lucky enough to become the Aetna Chief Digital Technology Officer about four years ago. And my focus is to create amazing experiences for our members, providers, and colleagues.

4:41We're always modernizing our platforms and now looking to scale AI across everything that we do. I have about 6 ,000 dedicated technologists working every day across a couple of thousand platforms. So there is never a dull moment at Atena, I can tell you that.

5:04Peter High: Very interesting, and certainly gives a good indication of the remarkable scale that you operate at. You mentioned the members, providers, colleagues, constituents that you're thinking about as you think about removing friction, as you think about improving experience and the like. I imagine there's probably some overlap between the work you can do that influences each of those, but there are also some differences as well. Can you talk a bit about how you think about trifurcating, if you will, between the needs of members, providers, and colleagues and the thought process around what's common and what's unique to each?

5:37Yeah, yeah, for sure. So again, I mean, healthcare is super complex. If you think about traditionally, healthcare has not been designed around the consumer, right? It's always been around the provider or the payer or the health system. And so, you know, we have a unique position here. And I think at CVS and now, but in the greater healthcare ecosystem, we have the ability to transform that. And I think it all starts with that consumer. There is no other industry where we assign homework to the customer. And I always thought that was odd. And that's something I think we can change. And so we are very focused on how do you actually look at the friction points for the consumer?

6:32How do you put them at the center of their journey? And how do you help them get a better outcome? So that's kind of one constituent. If you think about the providers, you know, traditionally, we've been a paper based industry, where we trade either phone calls, or faxes back and forth every single day. And again, no other industry is doing that. And so how do you actually want a provider to work with you and have a great experience? And I know, Peter, you're a healthcare consumer, so am I. You never want to walk into your doctor's office or visiting your clinician and you tell them you're an Aetna member.

7:21You want them to be delighted. You want them to be excited. You want them to have a frictionless experience. And we think that if we can do that, it provides a better experience for both the provider and the member at the same time. And then lastly, we take 60 million calls a year at Aetna from members and providers, and how can you actually help the colleagues have a better experience internally, whether it's working on multiple systems, whether it's having to look at, you know, lots of PDFs and search through lots of documentation. How do you actually kind of reduce that administrative burden for the colleague?

8:09So when they're spending time with a member, it's actually fast, delightful, and they're getting the information as quick as possible.

8:20Peter High: And what are some of the, across your tenure now in your current role, what are some of the friction points or frustrations that you've helped resolve using technology? I wonder, you mentioned that earlier, and great insights you just shared as well. I'd love to understand more about the resolution there based on your diagnosis. Yeah, just a couple of great examples. First off, in the member experience, when I started here at Aetna, I've told this story a couple of times, Peter, I joined a lot of CIO advisory boards. So I'm sitting with maybe 12 other payer CIOs. This is about three and a half years ago.

9:05And we went around the room. And luckily I went last. And they said, hey, what are you going to focus on for the next three years? Where are you making your biggest investments and bets? And where do you think you can change healthcare? Every single one of them was talking about utilization and how do we handle the cost of care and sort of going through each one of those transforming technology. Maybe it was cloud back then. And it got to me and I said, hey, the biggest thing that I'm working at and my biggest bet is changing the member experience and investing in our digital experiences to bring the consumer to the center of what we do.

9:47And everyone kind of looked at me and said, that's your biggest bet. And that's what we've done. We are really proud of the progress we've bid around the member experience. We have a leading digital app now. And, you know, one of the biggest changes that we've saw, Peter, again, we assign homework in healthcare, which we shouldn't do. We also, it's the only industry where you're committing to a service, but you don't know what the cost is going to be. And again, that is just a foreign to me. And so we launched and built from the ground up over the last 18 months a brand new cost estimation product that has over 20 ,000 medical services in there.

10:39And we've saw our adoption or usage on our digital properties where a member can go in there with natural language using AI and find the cost of care for simple and complex procedures. In our old model, it was around less than 10%. Now we're seeing almost 70 % of people using that function and capability before they actually go in and have a procedure. And so we've gotten great feedback on that. And again, no other industry do we make you do homework and, you know, the cost and we're taking those things away.

11:24Peter High: Very interesting and compelling. I'd love to also understand, Nathan, how do you measure whether a digital experience is actually improving health outcomes at the end of the day, which, you know, I suppose is really the coin of the realm, so to say, making sure that those, you know, people who are your end customers are actually improving their health as a result of of your collaboration with them? How do you, how do you, how do you do that? Yeah. So, so first we, we have an amazing digital team. When we started this journey, we, we thought about all of the other companies that we work with and Peter, we work with some of the best companies in the, in the U S think financial services, technology companies.

12:13and we sort of took our inspiration from them. We looked at their digital experiences and their member experiences, and we still do to that. And we said, hey, how do we create that same frictionless experience in healthcare? And how do we measure the results of that? And traditionally in some of those other industries, it's NPS or customer staff, which obviously we do too. But for us, it's around better outcomes and I'll just give you a couple of examples. We track our digital experiences and our features through a bunch of sophisticated signaling. But what I think is more important is we do a lot of A-B testing.

13:00So we'll have our cost estimator product. We know what the previous experience was. As we start to release new capabilities, we'll try a couple different avenues. And we'll see which one has better adoption. We'll see which one has better results and where people are actually, you know, working and managing that.

13:26I'd say that a couple of other things. We measure the cost of care. We measure prior authorizations and how we can automate those. And then in terms of medical costs, we're able to track back some of the features and proactive outreaches. And we have signaling that says, hey, if we can get someone into a clinical setting where we can get vaccinations or we can get preventative care, does that avoid an emergency visit? Does that avoid a more complex surgery or procedure? And so we have a lot of modeling and predictive analytics that helps us do that.

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15:34Peter High: And now back to the interview. Given the, speaking of that modeling and predictive analytics, I'd love to understand the data program you've put together. You mentioned AI, and I'd love to delve into that in a moment as well. But as a necessary ingredient and foundation to getting that right, getting one's data right, so to say, is a key element to that. And I can only imagine, given the scale of what you've described in terms of Aetna's business, CVS Health, more generally speaking, data rich, but also it's a challenge given the vastness of that data as well. Talk a bit about the data program you've put in place to help ensure that you're able to maximize the insight you might derive from it.

16:16Yeah, Peter, I am grateful for the work that we did. I'd say COVID era, we were looking out the next three, four, five years. And we decided that at that time, and I was in a different role, but I was part of the strategy to build this new enterprise data platform, where we're taking all of the data sources across CVS Health and putting it into really one location that allows us to be able to use that data across the entire life cycle of a consumer. And then we also invest in something called our clinical data repository. Clinical data is traditionally been all over the place. you know, providers, payers, and we invested, this was about five years ago, and really said, hey, the future is having a single repository where we're able to have all of our clinical data stored and be able to do a clinical data exchange with our key providers and constituents.

17:33And that's really been sort of the foundation for us to build off of. And before we get into the AI conversation, you would not have been able to do the things that we're doing today with AI and machine learning and all of the great predictive and proactive outreaches if you didn't have your data organized in the right place and have the foundation set. You know, and as I talk to a lot of CIOs in other industries, they're doing that work today. And that's the reason, you know, I'm really grateful that, you know, we had a head start on it.

18:14Peter High: Well, let's talk a little bit about artificial intelligence now. On top of that foundation you established that you just described, Nathan, what are some of the use cases, the incorporation into workflows that have you most excited where you believe the most value might be derived? Yeah, so a couple of things. We at CVS Health and AdNow, we believe that AI should help the human interface. It's AI and the human that's going to create a better experience. And so we've spent a lot of time looking at those friction points and we're using AI to kind of enhance that human experience. The best example that I have today that I've talked about a bit in the past is we have over 15 ,000 nurses in our care management team.

19:15And so think about a member that may have been diagnosed with cancer or some other condition. We assign a care manager. That nurse does a telephonic or a virtual outreach. And if you think prior to AI, multiple system, lots of data, lots of clinical notes they needed to sort through. and honestly the feedback from our nurses was that's not what they signed up to do when they wanted to become a nurse. It wasn't to go through hundreds of pages of documentation. They want to have that human interaction and help that member who's been recently diagnosed get the care they need. And so we used AI, ambient listening, we're using it to summarize the clinical case notes prior to the conversation, helps them prepare, and then afterwards takes all of the information, bundles it up and summarizes the case.

20:27So we're able to go and take actions. And it's actually giving our nurses 90 minutes back per day. And so that's not about reducing the workforce, that's around allowing our nurses to spend more time with these patients who now we can talk about the condition. We can talk about the points of care. We can talk about if they need help or assistance getting to that care. And then, hey, post-surgery, how are you going to manage? Can we help you do that? Are there ways that Aetna can intervene? And And that has been game changing for the member and our colleagues. And so that one to us has been just a home run.

21:15Peter High: I can understand that. Very compelling. Thank you for sharing that, Nathan. Can you talk a bit about the guardrails you and the team have put in place to ensure that his AI gets more involved in very private information, of course, relative to health care, health outcomes, even guidance? How do you think about the guardrails to ensure that that's done safely and effectively? Yeah. So, Peter, we have a long history of machine learning and analytics and AI. We have over 3 ,000 data scientists at CVS Health that over the last 10 or 12 years were working on AI and ML. So we've had a long history of responsible AI and governance, which obviously we're committed to.

22:01privacy and security is fundamental to healthcare and trust. So we have a robust AI governance model. Every one of our AI use cases goes through this model. Again, it's around building that trust, making sure we have the right guardrails, and making sure that any AI use case follows that framework that we've established. The one thing that I would say is trust is so important in healthcare, right? We've built this trust over 170 years at Aetna with our members. They know that they can talk to our care managers, our nurses. We're going to get them the information that they need, and we're going to help them on their healthcare journey.

22:54And so AI is to augment that. And we want to make sure that we're using it appropriately and transparently with that.

23:05Peter High: Again, very compelling. Historically, Nathan, healthcare generally and health plans more specifically have been seen as very reactive. And I wonder, I'm starting to hear the seeds of what you're describing in going from reactive to proactive or perhaps augmenting a stance that's been in place to be more proactive in terms of guidance. And I wonder, you know, how do you think about that and being a more proactive partner in a member's health journey? Yeah, you know, it goes back to historically, the healthcare experience hasn't been focused around the consumer. And so now, if you shift the dynamic to member experience, consumer experience, removing the friction points, AI now enables you to take all that data that I talked about earlier.

23:56Now we have all the clinical data, very rich data set. We have a great trust and relationship with our members. They're using our digital properties. And then we can now use AI to augment that and get them what we call next best actions, right? It's really around sort of that preventative care that we can provide. We actually were the first payer about six months ago to roll out the use of rich communication services. And so think about previously we were using basic text and SMS to give our members proactive nudges on maybe vaccinations or their preventative care visits. And now we're able to actually provide a full digital experience through RCS on Android and iOS.

25:00And if you think about they're using our digital properties, they have the look and feel, they understand that they're able to select or actually kind of view tiles on more information, find a provider if they don't have one. And now we're bringing all of that into a native text channel. And it has been an amazing success for us. The engagement numbers right now in RCS versus SMS, over 80%. And we're seeing less than fewer, less than 50 % fewer app doubts there. So again, it's about building that trust. They know it's the Aetna digital experience that they use in the app. They see it in their text channel, and they're more likely to engage and interact with it.

26:01And again, you asked earlier about how are we measuring the outcomes. We're then taking that and we're watching it flow through the system. If we can get them into preventative care, we're going to see less complex procedures and better outcomes for the member.

26:21Peter High: Very interesting. You know, one of the strikes me as you were describing the scale of your operation, your team, even the members that you touch, it's an extraordinary amount of data that I can only imagine, you know, it's difficult for other organizations to match the statistical significance of the insights you can draw. That's a major advantage to the scale of your business. One of the challenges, no doubt, is as you contemplate the changes suggested in ways of operating, incorporating new methods and technologies, changing the patterns and ways of working for a vast number of people, 6 ,000 on your team alone, as you mentioned, is itself a challenge.

27:02Peter High: And I wonder, how do you think about the change management associated with some of what you're describing, which are consequential changes and improvements in the way in which the organization operates? Yeah. I think there's just a general nervousness in, I'd say, across lots of colleagues, but not just in the healthcare space. Again, I work with a lot of CIOs and other industries, and a lot of nervousness on both sides. The consumer, where is AI being used, and how is it being used? And then on the technology side, are we picking the right use cases? are we enhancing the colleagues? Are we replacing them?

27:52And we've been really clear in our vision. Our vision is to use AI and humans together, like I said earlier. And we've been very transparent with all of our colleagues on the solutions. And Peter, We've actually built a product orientation model here at Aetna, where when we're building products and capabilities, it is not technology going off and developing an AI product and coming back and saying, here we have it. It's a pot of people that collectively build that product. So that is a technology engineer, technology product manager, our business product manager, and we collaborate together. And so that iterative approach has helped us bring our colleagues into the development cycle.

28:53And when we're rolling out these new tools to our care managers or our AI agents to our member services, colleagues who take those 60 million calls, they're in the development cycle. So when it comes out, they're actually really excited to iterate and provide feedback. And then another, I think, amazing thing our team has done within many of our products, we provide instant feedback on the results. And that's helped us not only tune our models, but understand the usage on an hour by hour, day by day basis. And again, I think bringing the colleagues that use the technology into the development cycle, I think that just helps us deliver way better products.

29:49And then they helps with the change management. They feel like they have contributed and it's not a technology product. It's a product that they've actually built.

30:01Peter High: Very interesting. As you think about your tenure, 13-plus years in the company, more generally speaking, the very fast pace of innovation in recent years, the tremendous change that you're describing that's already in place but also what's to come. As you look ahead, let's say five years, what excites you in terms of the change that may continue to evolve, that impacts members, that impacts the company, providers, et cetera? Where do you see health care at the back half of this decade and the early part of the next one? Yeah, I'm super excited about it. I think AI and interoperability and the connectedness that we're going to see is going to reimagine healthcare completely.

30:47We started the interoperability journey years ago. I think there was slower to start. But now with AI and the ability to exchange data in real time, I think that is going to be the game changer. And when I think about reimagining health care, I think about it across kind of four different dimensions. We've talked a lot about the consumer health care experience. you're going to see that continuing to change. The consumer is going to be at the center of that and they're going to be able to make decisions. Like I said, they're going to be able to choose providers based on cost like we do in other industries.

31:37I think there's going to be a shift in consumer-centric clinical experiences. You see that today with a lot of the AI clinical products that are coming out. And if you talk to consumers, you know, they're not afraid to use the AI frontier models to understand conditions and to get care. I think you're going to see AI continue to simplify operations and kind of reducing that administrative burden. You're seeing that across the board with, you know, member services and lots of lots of administrative work that it's being automated. And then I think the last frontier is truly disruptive technology health care models.

32:29So digital first, you know, health care models where the human touch may be in the back or taking, you know, a second or third row. I think you're going to see that become a more robust operating model out there in the future. I also think that AI is going to help address with cost. I think it's going to drive down the cost of care because we're able to reduce a lot of that administrative burden. And then we talked a lot about the predictive nature of health care. If you can use AI to prevent, you know, chronic disease or acute conditions, I think that is a game changer. And not just for, you know, health care and the cost of health care in America.

33:22I think it's what we're here to do. Help people have better lives and have less time spent in the health care system.

33:35Peter High: better outcomes at lower cost sounds like a pretty compelling uh vision for the future certainly nathan i'll sign up for that um yeah for sure right me too well i before i let you go i wanted to see nathan if there's anything you'd recommend that you read or that you listen to that helps you stay current in the sorts of topics we're talking about uh in this conversation or beyond it as well um you know what do you what do you what do you consume in order to remain current Well, first and foremost, I have an awesome team. We believe in continuous learning at Aetna. And I spend a lot of time in weekly product reviews sitting with those teams I talked about.

34:16We also have a service excellence kind of workforce that we sit with every week, every couple of days. And I get a pulse on what's happening across the Aetna ecosystem. Personally, I have a 24-year-old that's in her first technology role and a 21-year-old who is interning. So I get a daily dose of what early-in-career technologists are dealing with, whether that's on AI or trying to keep up with trends. I had a great example the other day, Peter. I certainly I know about, you know, GLP-1s and, you know, peptides. They were educating me on the other peptides that are out there in the world and being used that are unregulated.

35:14And honestly, it was something that I wasn't aware of. And I went back and I did a bunch of research on it and came back and asked a bunch of questions. And so things like that, you know, I wouldn't get in my normal day to day conversations if it wasn't for them. And then over the past, I guess, six or eight weeks, we watched a ton of World Cup. I think I've watched more soccer in the last six weeks than I watched in the last six years. So I was excited to be able to spend a lot of time with my family and do that. And then, you know, just I mentioned it earlier, but I'm really grateful to be part of a number of CIO advisory boards.

36:02And these are less about health care technology and companies. These are cross-industry, global organizations, U.S. organizations. And the CIOs and I have amazing conversations around all types of technologies, including AI. And it really does help me kind of bring an outside view into healthcare.

36:35Peter High: Yeah, the importance of one's ecosystem, and especially as you call out so compellingly, of thinking about the reverse mentorship of those who were earlier in their career and therefore don't have the intellectual baggage perhaps some of us have of our experience. Super interesting in terms of the way in which you think about that as well. Thank you, Nathan, for sharing that, but also for a great conversation beyond that. Remarkable, the work that you and your team are doing at scale to improve healthcare outcomes. And I certainly hope that the vision that you paint is one that will be realized.

37:06Peter High: We'll look forward to staying tuned in on that. But thank Thank you so much, Nathan, for a great conversation today. Peter, thank you so much for having me. This was a great time and it was really nice meeting you. Thanks for listening to Technovation. If you enjoyed this conversation, subscribe and leave a rating. It helps more leaders find our podcast. Thank you, and I look forward to seeing you next time.