How Aetna Is Scaling AI Across Healthcare with a Unified Data Foundation
forbes.com

How Aetna Is Scaling AI Across Healthcare with a Unified Data Foundation

Tech News
2 min read

Published by AINave Editorial • Reviewed by Ramit

TL;DRAetna is deploying AI across member pricing, nurse workflows, and proactive outreach, built on a unified data foundation. For AI builders, the key is pairing data infrastructure with human-in-the-loop governance and measurable care outcomes.

Aetna, the health benefits arm of CVS Health, is deploying AI across member pricing, nurse workflows, and proactive outreach, all built on a unified data foundation established during the pandemic. For AI builders, the initiative demonstrates how a large payer can scale AI by pairing data infrastructure with human-in-the-loop governance and measurable care outcomes, rather than chasing automation for its own sake.

A unified data foundation built before the AI boom

During the pandemic, CVS Health developed an enterprise data platform and a Clinical Data Repository to consolidate clinical information and enable exchange with providers. Nathan Frank, Aetna's Chief Digital and Technology Officer, emphasized that without organized data, the current AI capabilities would not be possible. This foundation now supports real-time AI-driven care orchestration across multiple domains.

Pricing transparency: from under 10% to nearly 70% adoption

Aetna rebuilt a cost-estimation product covering more than 20,000 medical services. Members can use natural language and AI to estimate the cost of procedures before receiving care. Usage rose from under 10% to nearly 70% among people using the capability before a procedure. The company evaluates such products by connecting digital interactions to care costs, prior authorization automation, and health outcomes.

AI that gives nurses 90 minutes back each day

Over [15,000 nurses

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