Aetna's New Initiatives to Enhance Healthcare Experiences for Providers and Patients

Aetna®, a subsidiary of CVS Health® (NYSE: CVS), is making significant strides in transforming the healthcare experience for both professionals and patients. Announced on December 4, 2025, the company introduced innovative strategies aimed at reducing systemic friction, which was part of a comprehensive plan that began earlier this year. Steven Nelson, President of Aetna, emphasized their commitment to working collaboratively with stakeholders to create a simpler healthcare system, ultimately enhancing user experiences for consumers seeking affordable and personalized care.

Reducing Friction in Prior Authorization Processes

One of the notable advancements in Aetna’s approach is the bundling of prior authorizations. This is designed to minimize the cumbersome bureaucracy that often complicates patient care. Prior authorization is essential in safeguarding healthcare quality and ensuring proper insurance coverage; however, it can also hinder efficient service delivery. Aetna's new model integrates pharmacy prescriptions with medical procedures into one review process, significantly simplifying what was previously a two-step authorization protocol. For instance, instead of requiring providers to submit separate authorizations for procedures like in vitro fertilization (IVF) and the corresponding medications, the new system allows providers to file a single prior authorization. If the initial medical procedure is approved, related medications automatically gain approval under Aetna's pharmacy plans, reducing unnecessary delays in patient care.

This innovative approach launched in November 2025. Aetna also expanded its offerings to include a specialized musculoskeletal bundle, which encompasses key medical services such as imaging, knee surgeries, and ancillary medications to ensure patients receive comprehensive care without the added burden of navigating multiple approvals. This initiative builds upon similar bundles introduced for cancer treatment earlier in the year, showcasing Aetna's commitment to streamlining processes across diverse medical needs.

Innovative Care Delivery Models with Aetna Clinical Collaboration

In addition to improving prior authorizations, Aetna is revolutionizing how care is coordinated through its Clinical Collaboration (ACC) program. This initiative fosters partnerships between Aetna nurses and hospital staff to better assist Medicare Advantage beneficiaries in their transition from hospital care to home or skilled nursing facilities. The program aims to reduce 30-day readmission rates and hospital stays by 5% once it is fully operational. Currently, the ACC is being implemented in 17 hospitals, with plans for widespread adoption throughout Medicare and commercial health plans, underscoring Aetna's focus on quality healthcare delivery.

Leveraging AI for Enhanced Member Experience

As part of a substantial investment totaling $20 billion in digital solutions, Aetna is integrating AI capabilities within its healthcare offerings. The Aetna Health app is set to transform member interactions by providing an advanced conversational AI feature, enhancing the overall member experience. This functionality goes beyond standard chat support, delivering a fully integrated digital navigation tool that facilitates a seamless experience from initiation to follow-up care.

Additionally, Aetna is implementing technology-driven innovations across its operations, including claims processing and client onboarding, aiming to build a best-in-class healthcare system that prioritizes simplicity for customers, members, and healthcare providers.

About Aetna and CVS Health

Aetna, as part of CVS Health, serves approximately 37 million individuals, offering a comprehensive range of health insurance products designed to empower consumers in making informed healthcare decisions. Its services encompass medical, pharmacy, dental, and behavior health plans, reflecting the company’s commitment to diverse healthcare needs. CVS Health itself is a major player in the healthcare sector, with a robust infrastructure that includes nearly 9,000 retail pharmacy locations and various healthcare services supporting millions across the United States.

For more information on Aetna's innovative solutions and offerings, visit Aetna.com.