CVS Health leaders on reducing healthcare’s biggest problems
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This week in Las Vegas was AHIP 2026, the annual conference hosted by the nation’s leading trade association for health insurers.
The two-day event featured discussions from across the healthcare landscape, from new industry commitments to prior authorization and the growing role of AI to ongoing debates about how to balance pharmaceutical innovation with affordability.
CVS Health spoke with CNBC about how the company is using AI and other technologies to reduce administrative burdens and provide more personalized, proactive care experiences.
Below are some highlights from the conversation with Katerina Guerraz, chief operating officer of Aetna and president of Medicaid, and Tilak Mandadi, chief experience and technology officer of CVS Health.
Real-time data sharing could be a game-changer
Guerraz said some of the health system’s biggest vulnerabilities may be more easily addressed in the next few years as insurers and providers work to reduce administrative burdens and share data more seamlessly.
She noted the industry’s existing efforts to streamline prior authorization and other insurance processes, but said greater “interoperability” between payers, providers and other health care stakeholders could be the “bigger thing that transforms this industry” in the next three to five years.
“When someone in the healthcare ecosystem starts sharing data in real time, it actually changes everything,” Guerraz told CNBC. “You don’t use all these different intermediaries of people processing different types of information.”
This could help patients access medical care more quickly, she added.
Conversational AI tool could help patients
CVS believes its interactive AI assistant, which launched on Aetna’s website and mobile app in the fall, can help members navigate the health care system more easily by answering questions, anticipating needs and reducing the need for customer service calls.
The assistant is intended to go beyond the capabilities of traditional chatbots and automated phone systems, Mandadi said. Rather than simply answering a member’s question, the tool aims to understand what the person wants to achieve and guide them through the next steps. For example, a member asking whether a surgery is covered could also receive information about expected out-of-pocket costs, pre-authorization requirements and in-network care options, he added.
“We know why people call us most of the time. How can we solve these problems and give them answers before they even have to reach out?” Mandadi said. “But if it does, conversational AI is the one that can do it faster.”
He said it was a proactive approach that gave members information before they even had to pick up the phone – and the company had benefited from it too.
Mandadi said the company’s pharmacy business previously received more than 500 million calls annually, many of which were simple questions such as the status of a prescription. But today, about 75% of those interactions are solved entirely by conversational AI, freeing pharmacists and customer service representatives to focus on more complex issues, he said.
Personal AI assistant could anticipate patient needs
CVS also envisions a future where patients can have a “persistent” AI personal assistant that actively manages and anticipates their needs in real time, Mandadi said.
This is a key feature of CVS and Google Cloud’s Health100 platform, scheduled to launch later this year.
The AI assistant would monitor a member’s insurance, pharmacy and clinical data and guide health decisions over time, he said. This tool goes beyond today’s chatbots: Mandadi described a consent-based system that keeps a continuous overview of a member’s health history, complaints, medications, and services and uses that information to anticipate needs rather than just respond to questions.
It’s another example of healthcare interactions shifting from reactive to proactive, Mandadi said. Instead of waiting for members to call with questions or missing important steps in their care, Assistant flags issues in advance and suggests follow-ups and recommendations in real time.
He said the goal is to reduce the “health care homework” that patients often have to deal with on their own, such as: B. understanding benefits, dealing with chronic illnesses or tracking appointments and medications.
The assistant could even detect early warning signs, such as missed medication refills or worsening health indicators, and intervene before these escalate into more serious problems.
He said the system would eventually integrate multiple data sources, including claims data, pharmacy records, electronic health records and possibly wearable devices, provided patients give consent.
Mandadi said the assistant could ultimately help patients achieve better health outcomes and reduce their out-of-pocket costs.
“That’s the really nice thing about it,” he said.
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