Aetna Accelerates National Strategy to Simplify Healthcare for Providers and Patients Through Innovation, AI, and Integrated Care Models
Aetna®, a CVS Health® company today announced significant progress on its ambitious, system-wide initiative to eliminate friction across the U.S. healthcare ecosystem—a strategy first unveiled in June 2025. These milestones reflect Aetna’s ongoing commitment to transforming the healthcare experience for both providers and patients by leveraging clinical expertise, advanced technology, and strategic partnerships to drive simplicity, affordability, and personalization.
“Aetna made bold commitments earlier this year to reimagine how Americans experience healthcare,” said Steve Nelson, President of Aetna. “I’m proud of the tangible progress we’ve achieved in just a few short months. By collaborating closely with providers, plan sponsors, and technology partners, we’re proving that simplification is not just an aspiration—it’s an achievable reality. Our shared goal is to make the healthcare system easier to navigate, more responsive to individual needs, and fundamentally more human.”
The healthcare system has long been burdened by administrative complexity, fragmented processes, and inefficiencies that divert time and resources away from patient care. Aetna’s strategy aims to dismantle these barriers through three core pillars: streamlining administrative workflows, pioneering new care delivery models, and deploying intelligent, AI-powered digital tools that empower members at every step of their health journey.
Revolutionizing Prior Authorization Through Integrated, Condition-Based Bundling
One of the most persistent pain points for clinicians and patients alike is the prior authorization process. Though intended to ensure appropriate, evidence-based care, traditional prior authorization often results in delays, duplicated efforts, and frustration. In response, Aetna has pioneered a groundbreaking approach: condition-specific prior authorization bundles that unify medical and pharmacy benefits under a single clinical review.
This innovation marks Aetna as one of the first major national health insurers to integrate prescription medications and medical procedures into one seamless authorization workflow. Historically, providers treating a patient undergoing in vitro fertilization (IVF), for example, had to submit two separate prior authorization requests—one for the medical procedure under the medical benefit and another for the associated fertility medications under the pharmacy benefit. This duplication not only slowed treatment but also increased administrative burden.
Beginning in November 2025, Aetna eliminated this redundancy. Under the new model, providers submit only the medical prior authorization. If approved, all clinically aligned medications covered under Aetna’s pharmacy benefit are automatically approved—no additional paperwork required. This not only accelerates time-to-treatment but also reduces denials and appeals, improving outcomes and satisfaction for both clinicians and patients.
The IVF bundle is just the beginning. Also as of November 2025, Aetna launched a comprehensive musculoskeletal care bundle that includes imaging (X-rays), total hip and knee arthroplasty (THA/TKA) procedures, non-opioid pain management and anti-nausea medications, inpatient admission when necessary, infection prevention protocols, and durable medical equipment (DME). This holistic approach ensures that all components of an episode of care are evaluated together, reflecting real-world clinical pathways rather than siloed administrative categories.
This builds on earlier successes in oncology, where Aetna introduced bundled prior authorizations for lung, breast, and prostate cancer treatments earlier in 2025. Early data shows these bundles have reduced prior authorization processing time by up to 40% and improved provider satisfaction scores significantly.
Redefining Post-Acute Care Through Aetna Clinical Collaboration (ACC)
Beyond administrative simplification, Aetna is reengineering how care is delivered—particularly during high-risk transitions such as hospital discharge. Through its Aetna Clinical Collaboration (ACC) program, the company is embedding its care management teams directly within hospital systems to support Medicare Advantage members during vulnerable periods.
In ACC, Aetna nurses work side-by-side with hospital discharge planners, social workers, and clinical teams to ensure patients have the right support, medications, follow-up appointments, and home health services before leaving the facility. This close coordination helps prevent gaps in care that often lead to avoidable readmissions.
Preliminary results are promising. The program is projected to reduce 30-day hospital readmissions and shorten average hospital length of stay by 5% year-over-year once fully scaled. These improvements not only enhance patient outcomes but also generate substantial cost savings for the healthcare system.
Currently, ACC is operational in 17 hospitals and medical centers across the country. Aetna plans to expand the program to additional facilities in 2026, with extensions into its Commercial lines of business to serve a broader population. The model exemplifies Aetna’s shift from transactional coverage to proactive, relationship-based care—where health plans act as true partners in health delivery.
Empowering Members with AI-Driven Digital Navigation
Recognizing that digital experience is now central to healthcare access, Aetna is harnessing the power of artificial intelligence to transform how members interact with their benefits. As part of CVS Health’s $20 billion, multi-year digital transformation investment, Aetna has embedded generative AI deeply into its member-facing platforms—not as an afterthought, but as a core component of the end-to-end experience.
The flagship innovation is a next-generation conversational AI feature within the Aetna Health app, currently in pilot with select members and scheduled for broad rollout in early 2026. Unlike conventional chatbots that operate in isolated windows, Aetna’s AI is woven into the fabric of the app’s functionality. Members can ask natural-language questions like, “What’s the copay for my blood pressure medication?” or “How do I find a dermatologist near me who accepts my plan?” and receive accurate, personalized, real-time responses—without navigating complex menus or waiting on hold.
But Aetna’s AI ambitions extend far beyond consumer-facing tools. The company is also applying machine learning and automation to back-end operations, including claims adjudication, provider onboarding, and care management workflows. These enhancements reduce processing times, minimize errors, and free up staff to focus on higher-value interactions—ultimately creating a more responsive and reliable system for everyone involved.
“The future of health insurance isn’t just about paying claims—it’s about guiding people to the right care, at the right time, in the right way,” Nelson emphasized. “AI is the engine that makes this possible at scale.”
A Vision for a Frictionless Healthcare Future
Aetna’s progress underscores a broader industry shift toward patient-centered, integrated, and intelligent care. By tackling long-standing pain points—whether through bundled authorizations, embedded clinical teams, or AI-powered navigation—the company is demonstrating that systemic complexity can be unraveled through purposeful innovation.
Critically, none of these initiatives exist in isolation. They are interconnected elements of a unified strategy: simplifying administration enables better care delivery; better care delivery generates richer data; and richer data fuels smarter AI. This virtuous cycle positions Aetna not just as an insurer, but as a health partner equipped to meet the evolving needs of a diverse, aging, and digitally fluent population.
As healthcare continues to evolve in complexity and cost, Aetna’s work offers a compelling blueprint for how large payers can lead the charge in making the system more humane, efficient, and effective. With additional enhancements planned throughout 2026—including broader AI deployment, expanded ACC partnerships, and new condition bundles in chronic disease management—the company is poised to deliver on its promise: a healthcare experience that works for everyone. For more information on Aetna’s simplification initiatives and to explore the enhanced member experience, visit Aetna.com/simplify.
About Aetna
Aetna, a CVS Health business, serves an estimated 37 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care professionals, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit Aetna.com (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program).
CVS Health is a leading health solutions company building a world of health around every consumer, wherever they are. As of September 30, 2025, the Company had approximately 9,000 retail pharmacy locations, more than 1,000 walk-in and primary care medical clinics and a leading pharmacy benefits manager with approximately 87 million plan members. The Company also serves an estimated more than 37 million people through traditional, voluntary and consumer-directed health insurance products and related services, including highly rated Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company’s integrated model uses personalized, technology driven services to connect people to simply better health, increasing access to quality care, delivering better outcomes, and lowering overall costs.
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