Latest / Becker’s Payer Issues Podcast / Nathan Frank on Aetna’s AI Strategy: Reducing Friction Across Healthcare

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Nathan Frank on Aetna’s AI Strategy: Reducing Friction Across Healthcare · Becker’s Payer Issues Podcast

0:01
- The payer provider relationship has never been simple,
0:04
- but what's happening now is something different.
0:07
- Value based models are maturing unevenly,
0:10
- prior authorization reform is reshaping workflows on both
0:13
- sides, and affordability
0:15
- pressure is intensifying.
0:16
- The organizations that figure out how to collaborate
0:19
- genuinely, not just contractually,
0:21
- are the ones that will set the terms
0:23
- for what comes next.
0:24
- Becker's fifth annual fall payer issues roundtable brings
0:27
- together more than 500 executive level attendees
0:30
- and 70 plus speakers for two days of
0:32
- focused senior level conversation on benefit design, network
0:36
- strategy, transparency,
0:38
- and the financial and regulatory
0:46
- Hotel Chicago. For the agenda and event details,
0:49
- visit beckerspayer.com
0:50
- and click on the events tab in the
0:52
- upper right.
0:54
- Hello, everyone. This is Jacob Emerson with the
0:56
- Becker's Payer Issues podcast.
0:59
- Thrilled today to be joined by a special
1:00
- guest. Nathan Frank serves as senior vice president
1:03
- and chief digital and technology officer at Aetna.
1:07
- Nathan, thanks so much for taking the time
1:09
- to be with me on the podcast.
1:10
- Thanks for having me, Jacob. I'm excited to
1:12
- be here.
1:14
- Likewise, Nathan. And before we dive into everything
1:16
- we wanna chat with you about today, some
1:18
- interesting new updates and things going on at
1:20
- Aetna. Can you first fill in our audience,
1:24
- a little bit about yourself,
1:26
- your career journey at Aetna? I know you've
1:27
- been there for more than a decade now.
1:29
- So so talk to us a little bit
1:31
- about your background there. And then,
1:33
- for any of our audience members who might
1:35
- not be familiar, can you fill them all
1:36
- in on exactly what your role entails today
1:40
- at Aetna?
1:41
- Sure. No. No problem. So, I'm the chief
1:44
- digital technology officer at Aetna. I've, been, at
1:48
- CVS Health for
1:50
- almost fourteen years.
1:52
- I spent about,
1:54
- seven years in our Caremark,
1:56
- PBM and in running most of the technology
2:00
- in that in that business.
2:02
- I have the opportunity to,
2:05
- take an enterprise role for for about three
2:07
- years where I led our,
2:10
- cloud strategy
2:11
- and,
2:13
- established our our relationships with a lot of
2:15
- the technology
2:16
- partners that we,
2:17
- we host our our applications,
2:20
- now.
2:21
- And, I had the opportunity about four years
2:23
- ago to take the CIO role at Aetna,
2:26
- where I became,
2:28
- the chief digital technology officer along the way.
2:31
- And I'm responsible for all the technology
2:34
- and experiences
2:36
- for our 27,000,000
2:38
- members across
2:39
- our commercial,
2:41
- Medicaid, and Medicare,
2:43
- business segments.
2:45
- Wonderful. Well, I really appreciate you taking the
2:47
- time to chat with us, Nathan. I know
2:49
- you're a busy guy. So I'll dive right
2:51
- in. I wanted to ask you about,
2:53
- something that I I know you know you're
2:55
- familiar with, about your role balancing
2:59
- legacy claims and your pharmacy platforms,
3:03
- nowadays with a push toward more AI and
3:05
- more digital first experiences. So
3:08
- can can you levels up for our audience
3:10
- for a sec? How do you set technology
3:12
- priorities right now when you're accountable to so
3:15
- many different stakeholders?
3:16
- You mentioned 27,000,000
3:18
- members alone on the Aetna side. You've got
3:21
- your provider partners. You've got clients,
3:24
- with the wider c CVS ecosystem.
3:27
- How are you,
3:29
- staying on top of all of that and
3:31
- setting your priorities straight right now?
3:33
- Yeah. Absolutely.
3:35
- First, health care is complex, so we work
3:37
- in a a fairly complex
3:39
- industry.
3:41
- We also are part of CVS Health, which,
3:45
- creates its own,
3:46
- balances
3:47
- across a large enterprise
3:49
- like ours.
3:50
- But in Aetna, the goal is very simple.
3:54
- We focus
3:55
- on areas where technology can create better experiences
3:59
- for,
4:00
- first of all, our members,
4:02
- then our providers, but all but also our
4:05
- colleagues.
4:06
- And we,
4:08
- are out there to solve real business problems,
4:11
- and we focus
4:13
- on driving deliver and delivering
4:16
- measurable
4:17
- value back.
4:18
- So at the end of the day,
4:20
- you know, we're the only industry,
4:23
- health care that,
4:25
- assigns homework,
4:26
- And
4:27
- we we we don't think that should be
4:29
- the case.
4:31
- We're using AI and technology to simplify things
4:34
- like
4:35
- prior authorizations,
4:36
- appointment scheduling.
4:38
- But, generally,
4:40
- we want people to spend less time
4:43
- navigating health care and and more time focused
4:46
- on on their own health journey.
4:49
- And I just to kind of level set
4:52
- up how we we think about that, You
4:54
- know, we work with some of the,
4:57
- most amazing companies out there in in,
5:00
- financial
5:01
- or technology industries,
5:04
- and we take inspiration from them.
5:07
- And so
5:08
- we know that health care is complex today,
5:10
- and we believe that we're best positioned to
5:13
- remove
5:14
- that friction and and homework in health care.
5:18
- So we're using things like AI to take
5:21
- out, you know, all that busy work
5:24
- that slow,
5:25
- you know, our clinicians and our care teams
5:28
- down
5:28
- and get our members,
5:31
- you know, the care they need faster
5:33
- and easier.
5:35
- And, you know, just think about it, Jacob.
5:37
- Like, our clinicians
5:38
- and care managers didn't get into health care,
5:42
- to do a bunch of of documentation
5:44
- every day.
5:46
- And our members,
5:48
- when they're
5:49
- either diagnosed with, you know, cancer or some
5:53
- type of acute condition,
5:55
- they don't wanna have homework either.
5:58
- And so, you know, we believe that, you
6:01
- know, AI can help handle that homework.
6:04
- You know, things
6:05
- like appointment scheduling,
6:07
- where we can use AI and AgenTek AI
6:10
- to
6:11
- actually go out there and and schedule the
6:13
- appointment for a member. Again, makes it easier
6:16
- for them, but also makes it easier for
6:18
- the providers.
6:19
- And,
6:21
- you know, you'll see that, through the product
6:23
- offerings and, you know, our strategy.
6:26
- Again, grounded in taking that friction out and
6:29
- improving experiences
6:31
- across those,
6:32
- three cohorts.
6:34
- One of the things that that I talk
6:36
- about, and it's a great example,
6:38
- goes back to those clinicians.
6:41
- Again,
6:42
- they didn't get into health care to do
6:44
- homework. They they wanna help our members
6:48
- get to the right care.
6:49
- So using,
6:51
- you know, AI to help
6:53
- summarize
6:54
- clinical conversations
6:55
- or help them with case notes
6:58
- makes those conversation
7:00
- easier
7:01
- and gives them the time back to actually
7:04
- help that member,
7:05
- get to the right provider
7:07
- or, you know, help them with any of
7:09
- the other
7:11
- administrative things that that that are in health
7:13
- care today.
7:15
- Absolutely. So you're essentially saying
7:17
- artificial intelligence really presents an opportunity to break
7:20
- down friction, break down administrative barriers facing
7:24
- your members, facing your provider partners,
7:27
- and hopefully,
7:29
- improve the entire health care experience.
7:31
- I wonder, you know, going off that, Nathan,
7:34
- Aetna put out an interesting,
7:36
- survey or the results of a survey in
7:38
- July.
7:39
- The second one, the second provider survey you
7:41
- all have done, and it showed a provider
7:45
- payer trust score climbing to 6.1 out of
7:48
- 10,
7:50
- and and noting that there was big optimism
7:52
- around digital tools and and,
7:55
- their use cases for for what you were
7:57
- just talking about about really improving,
8:00
- some of the friction or reducing the friction
8:02
- that exists right now across the system.
8:05
- Let me let me ask you a pushback
8:06
- question about about the survey and,
8:10
- why should our our listeners, our readers,
8:13
- why should they treat these findings as credible,
8:15
- as actionable?
8:17
- Can you walk us through some of the
8:18
- methodology here,
8:20
- on on ultimately what you found?
8:23
- Yeah. Yeah.
8:25
- Yes. For first, Jacob, as I mentioned earlier,
8:28
- we're focused on creating amazing experiences. And, you
8:31
- know, we first started with, member experience, and
8:34
- and we quickly realized that there's a lot
8:37
- of opportunity to improve that provider experience, which
8:41
- takes that friction out of the entire ecosystem.
8:45
- The biggest takeaway, as you mentioned, is is
8:47
- really the,
8:49
- optimism and
8:51
- and trust, and we we know that's moving
8:53
- in the right direction.
8:55
- You know, our trust score
8:57
- increased,
8:58
- from four point, 5.4 to 6.1,
9:02
- which is important as well.
9:04
- And, you know, the overall goal of the
9:06
- survey is,
9:07
- to get feedback objective feedback
9:10
- from the provider market. So we can identify
9:14
- the right opportunities
9:16
- to improve that provider and payer relationship and
9:20
- continue
9:21
- to improve that that trust.
9:23
- So first, the short survey was conducted by
9:26
- a third party,
9:28
- included, you know, 700 plus participants across health
9:32
- systems.
9:34
- Think about physician, nurses, pharmacists, and and,
9:38
- and others.
9:39
- And the respondents didn't know that it was
9:42
- led by Aetna, and we didn't ask any
9:45
- specific
9:46
- Aetna questions.
9:48
- Instead,
9:49
- the responses were around
9:51
- the payers and and industry,
9:54
- you know, more broadly.
9:56
- So going back to that that trust component,
10:00
- we saw the areas of trust improve,
10:03
- including
10:04
- just as an industry,
10:06
- delivering on the promises,
10:09
- providing
10:10
- clear coverage information, some of the basics
10:13
- of helping, you know, our members and and
10:15
- patients just navigate
10:17
- the system.
10:18
- We also found that, you know, there's there's
10:21
- still more work to be done
10:23
- in that provider experience.
10:25
- But what I find interesting is that
10:28
- 53%
10:29
- of the respondents said that, you know, the
10:32
- health care system will become easier for patients
10:34
- to navigate.
10:35
- So
10:36
- they they feel that optimism
10:39
- with
10:40
- AI and the digital tools and just
10:43
- better access to information in real time.
10:46
- And,
10:48
- you know, that optimism
10:50
- is all around technology.
10:52
- So 84%
10:53
- of them are saying, that advances in in
10:57
- technology will
10:58
- not only reduce the friction,
11:01
- but also lead to better health outcomes,
11:03
- which is the goal of all of us
11:05
- in the industry.
11:08
- And and can you expand on that a
11:09
- little bit, Nathan, in terms of what Aetna
11:11
- is producing
11:12
- right now to turn
11:14
- those those aspirations or that optimism about,
11:19
- technology and real time data,
11:21
- and improving interoperability,
11:23
- which I know has been a really big
11:24
- push at the company.
11:26
- What you're doing right now that's that's turning
11:28
- that optimism into something that clinicians are using
11:31
- daily in their actual workflows?
11:34
- Yeah. Yeah. No. And it goes back to,
11:37
- you know, what I started in the within
11:39
- the beginning.
11:41
- Removing that administrative burden
11:44
- and
11:45
- helping the providers get the information that they
11:48
- need in real time,
11:50
- kinda reducing that overall
11:52
- friction. And we know interoperability has been around
11:55
- for a long time, but I do think
11:57
- the
11:59
- what we're seeing with our new
12:02
- AI tools, but also the
12:04
- the work that CMS has done to improve
12:08
- sort of the,
12:09
- interoperability
12:10
- standards and and push for that has been
12:12
- helpful as well.
12:14
- I also look at what we're doing
12:17
- in the digital tools.
12:20
- We've seen,
12:22
- improvement
12:23
- in patient navigation engagement.
12:25
- We're a leader in this space already, Jacob.
12:28
- We already have the number one web and
12:31
- app experience in the industry,
12:33
- and we know that our members
12:35
- who are engaged digitally,
12:37
- they can,
12:39
- make better decisions on health care. And we're
12:42
- using AI
12:43
- in our digital properties to help connect them
12:46
- to the right provider. And like I said,
12:48
- once we do that, we're using AI to
12:51
- help them actually schedule
12:53
- an appointment.
12:54
- And so that's sort of more on the
12:56
- the member side.
12:58
- When I think about the
13:00
- provider side,
13:01
- it's around that flow of information back and
13:04
- forth. And so a few ways that
13:07
- we do that. So think about our clinical
13:10
- data exchange.
13:11
- And, we partner with Epic through Epic player
13:15
- payer platform
13:17
- where we're able to exchange
13:19
- clinical data
13:21
- directly with those providers
13:23
- and identify
13:25
- care gaps, risks, and other things
13:28
- during the visit with a patient
13:32
- through the EHR.
13:34
- And
13:35
- that real time data exchange,
13:38
- helps to reduce
13:40
- any of that homework we talked about, but
13:42
- it also helps the provider.
13:44
- It reduces the,
13:46
- the inpatient,
13:48
- payment lag
13:49
- by 60%,
13:52
- and that means faster reimbursement.
13:54
- And so providers don't have to worry about
13:56
- that afterwards,
13:58
- less phone calls,
13:59
- less back and forth with with us.
14:02
- And then if you think about the the
14:04
- next leg of that is
14:06
- the bidirectional
14:07
- data exchange.
14:09
- So we're pushing the care gaps directly into
14:11
- those workflows,
14:13
- and we're able to actually,
14:16
- help the provider
14:18
- understand what they can do next.
14:20
- And
14:22
- in our opinion, that's sort of the the
14:24
- next horizon.
14:25
- You know, we're we're alive now with more
14:28
- more than a 120,000
14:30
- providers,
14:31
- and we share over 3,000,000 care gaps
14:34
- already,
14:36
- leading to better outcomes
14:37
- and partnering with the providers
14:39
- to get better care for our members.
14:42
- And then one of the bigger friction points
14:44
- that we've seen across the industry
14:46
- is with, prior authorizations.
14:49
- And so we partnered with Ahab, and
14:53
- we're a,
14:55
- a a great partner there. And we've built
14:57
- real time prior authorizations,
14:59
- and we can put those
15:02
- prior authorizations
15:03
- and the visibility
15:04
- directly into that provider workflow.
15:07
- So today at Aetna,
15:09
- we're already,
15:11
- doing real time approvals at 82%,
15:14
- for prior auths,
15:16
- and 95,
15:17
- available percent of eligible PAs are approved in
15:20
- twenty four hours.
15:21
- But there's room to improve. If we know
15:24
- it's a friction point,
15:26
- that
15:27
- clinical and bidirectional data exchange
15:30
- can take away
15:31
- all of that friction,
15:33
- and you'll see us, you know, continuing to
15:36
- push that
15:37
- as a,
15:39
- transformation in the industry.
15:42
- Absolutely. So clearly, making significant
15:44
- progress in a lot of areas, including prior
15:47
- auth, Nathan. And and I did see that
15:49
- ranking,
15:49
- by the way, and congratulations on the
15:52
- the the best mobile and desktop experience
15:55
- in the in the entire industry among all
15:57
- insurers,
15:58
- as of this year.
16:00
- I I wanted to ask you as well,
16:02
- because we've been hearing a lot of,
16:04
- leadership throughout the industry talk about,
16:07
- as they as they build more or integrate
16:10
- more AI into
16:12
- member and provider workflows,
16:14
- trying to also balance that line,
16:17
- of that integration
16:19
- with
16:20
- not introducing more confusion and not eroding trust
16:24
- in, across both cohorts.
16:26
- So can you talk to us a little
16:28
- bit about where you fall in that, what
16:31
- your
16:32
- overarching,
16:33
- thought processes around
16:35
- the line between
16:37
- AI integration more and more across health care
16:40
- and Aetna
16:41
- versus,
16:42
- you know,
16:43
- making sure your your members and your provider
16:45
- partners
16:46
- trust,
16:47
- what you're doing?
16:49
- Yeah. First, thank you for the the comment
16:52
- on the the member experience.
16:54
- You know, something that I'm personally
16:56
- proud of, and and I'm
16:58
- we have an amazing team that
17:00
- you know, we set out a goal three
17:02
- years ago to be
17:04
- number one in the industry in member experience,
17:07
- and
17:08
- and we're just proud to be, you know,
17:09
- recognized and and validate the work we're doing.
17:13
- I also look at
17:14
- at taking that same
17:17
- methodology and the same,
17:19
- strategy and applying that per to provider experience,
17:23
- And you're gonna see us,
17:25
- continuing to do that and striving to be
17:28
- the best in the industry over the next
17:30
- couple of years.
17:32
- When it comes to
17:34
- AI and health care,
17:36
- I do think that
17:38
- I, or I find
17:40
- that when I'm out there talking to
17:42
- a lot of the industry folks that
17:46
- AI alone will not
17:48
- transform health care.
17:50
- Right? The the greatest value
17:53
- we believe
17:54
- is the use of AI to support our
17:57
- colleagues,
17:58
- and it's really
18:00
- AI plus the human touch
18:03
- that's gonna actually transform this industry
18:06
- and transform the way that, you know, care
18:08
- is delivered.
18:10
- So we focus on the the practical use
18:14
- cases that
18:15
- save time, simplify processes,
18:18
- remove that friction that I talked about.
18:20
- And the goal is to give
18:22
- the providers,
18:24
- our clinicians and colleagues,
18:26
- and all of our members
18:28
- more time back.
18:31
- And we have a long history of of
18:34
- AI
18:35
- at CVS Health
18:37
- and and Aetna.
18:38
- We've been doing this for,
18:40
- you know, greater than ten years. We have
18:43
- thousands of data scientists that
18:45
- have been working
18:47
- on sort of the precursor to AI
18:49
- and using machine learning and other techniques,
18:53
- you know, to solve, you know, fraud, waste,
18:54
- and abuse and,
18:56
- to help,
18:58
- you know, improve the
19:00
- the health care ecosystem by taking out cost
19:02
- and reducing that burden.
19:04
- AI has widened the aperture to that,
19:07
- but it hasn't changed our
19:10
- methodology
19:11
- around
19:12
- grounding health care in that human touch.
19:16
- So we're committed to the responsible
19:19
- use of AI.
19:21
- We have the proper safeguards in place,
19:24
- that reduce the the risk of bias and
19:26
- hallucinations.
19:28
- We have a very robust industry recognized governance
19:32
- model.
19:33
- We've also built AI in to help our
19:36
- our colleagues,
19:37
- move fast, but also,
19:40
- build that trust
19:42
- that's so important in health care.
19:44
- And,
19:45
- again, it's really about
19:48
- solving
19:49
- problems and removing friction for
19:52
- those three codes that I talked about.
19:55
- The member experience, we're we're doing an amazing
19:58
- job.
19:59
- Provider,
20:00
- we are you're seeing the results, but we
20:03
- have some work to do.
20:04
- And then with our colleagues,
20:07
- helping them
20:09
- create and maintain
20:11
- that human connection
20:13
- and really build that trust.
20:15
- So
20:16
- AI should
20:18
- augment all of that work,
20:21
- not
20:22
- replace, you know, the work that our,
20:24
- Aetna colleagues do every day.
20:27
- Well, we're seeing
20:28
- billions this year, Nathan, of dollars being poured
20:31
- into
20:32
- AI across the industry, just insurance alone. And
20:35
- so
20:36
- before we go,
20:38
- the last question I'd ask you is if
20:41
- if you could tell our tell our audience
20:43
- of of other leaders out there,
20:45
- how should they be thinking about this as
20:47
- this journey continues across the industry at their
20:50
- respective companies?
20:52
- Are there any industry wide missteps or strategies,
20:56
- that you're really keeping an eye on right
20:57
- now? Any any final bits of advice you
21:00
- would offer our listeners today in this space?
21:04
- Yeah. Jacob, I I work in a a
21:06
- a large enterprise.
21:08
- I
21:09
- see a lot of,
21:11
- startups in this space
21:13
- wanting to come in and transform health care.
21:17
- Many have great ideas,
21:19
- but they don't have the scale, and they
21:21
- don't have the trust
21:24
- that we have with our our members and
21:27
- providers.
21:28
- And the the one piece of, you know,
21:30
- advice I
21:31
- I I often,
21:33
- you know, give many of these
21:35
- leaders is
21:36
- you really have to establish
21:39
- a
21:40
- a methodology
21:41
- and
21:42
- and strategy around building that trust.
21:46
- AI is gonna be an amazing,
21:49
- tool to help accelerate
21:52
- the work that we're
21:53
- doing, but it's not gonna replace
21:56
- the human touch in health care. And as
21:58
- a consumer,
22:00
- you know, Jacob, you're a consumer as well
22:02
- of health care,
22:03
- and it's great when you can go to,
22:07
- you know, a digital property, an app, a
22:09
- website, and get the information you need and
22:12
- and maybe find out, you know, some of
22:16
- of the navigation
22:17
- techniques or even
22:19
- understand better what your symptoms might be.
22:22
- But when you need to talk to someone
22:24
- in health care or you need to go
22:26
- see a clinician or a primary care
22:29
- physician, you wanna be able to do that
22:31
- quickly,
22:32
- and the tool should help you
22:35
- get that care.
22:36
- They shouldn't
22:38
- do it for you or do it in
22:40
- place
22:40
- of that human touch.
22:42
- And I I think it's important just to
22:44
- keep
22:45
- the the members, providers at at the center.
22:48
- And,
22:49
- you know, hopefully,
22:51
- hopefully, that's the goal for everyone.
22:55
- Absolutely. Well, I think that's a good place
22:57
- to leave things, Nathan. So I wanna thank
22:59
- you for taking the time to chat with
23:01
- us and for sharing your expertise
23:04
- with our listeners. We really appreciate you doing
23:05
- so.
23:06
- Thank you so much, Jacob. It's, been a
23:08
- great time.
23:09
- And to our listeners, if you'd like to
23:11
- listen to more podcasts from Becker's, you can
23:13
- visit beckers hospital review dot com.