Becker's Hospital Review

12 COO e academy has been paired with operational deployments — including AI tools for Aetna's more than 15,000 nurses that pull information from multiple systems and summarize it before member calls. e feedback from staff was overwhelmingly positive, though it came with an important message about pace. "ey said to us, 'ese tools are great, but think about the pace, because there's only so much we can absorb. We've done the AI Academy, you're launching these new tools, making our jobs easier so we can actually spend more time with people instead of just handwriting notes all the time,'" Ms. Guerraz said. "So I think that's where we've been listening — we have to pace this in a way that the workforce is using it at the top of their license." Pacing the workforce through change Aetna has also mapped out what its workforce will look like two to three years from now, identifying which roles AI will augment and planning accordingly. One commitment remains firm: anyone who wants to speak to a human will always have that option. "We have AI agents who are helping proactively solve issues and answer basic questions, but anyone who calls that number will always have the opportunity to talk to someone," Ms. Guerraz said. "at's not something that's going away." Aetna's provider survey reinforced what many in the industry already suspected — administrative ease remains the top priority. But the COO said there was also a more optimistic signal in the data that she didn't want to overlook. "I think generally the health systems and the providers in the survey who participated recognize that it is different now — we need to figure out how the system works differently and better together," Ms. Guerraz said. "ere's a lot of openness to do things differently from a clinical collaboration point of view." One area that has gained traction is discharge planning. Aetna's clinical collaboration program, now live in roughly 24 facilities, places nurses on-site at hospitals to help coordinate transitions and ensure members understand what benefits and services are available to them — work she said providers have genuinely welcomed. "It isn't the doctor's job to educate a member on their benefits," Ms. Guerraz said. "But we are working collectively to say, 'Hey, the right thing is for this individual not to have to get readmitted and to get healthier.'" Interoperability surfaced repeatedly in the survey as the most stubborn unresolved challenge — and she was direct about why it matters so much. "I think interoperability is a big hiccup in the system – it creates a lot of friction," Ms. Guerraz said. "Once we can get the data connected seamlessly, patients will be able to access care faster and it will make for a better overall patient experience." Removing the homework On the member side, Aetna's focus has been on what the COO describes as removing the homework — the burden members carry when trying to figure out what's covered, where to go and how to get there. "Our job is not just to take the member out of the middle, but also get rid of and remove the homework that a lot of patients and members have when they're trying to figure out, do I have this benefit covered, where do I go for this," Ms. Guerraz said. "All the tools that we've been rolling out right now are focused on navigation — we want to take the homework out where we're proactively connecting information to members." Intelligent matching is one example, using Aetna's data to connect members with physicians who not only match their language preferences and location, but who are demonstrably seeing new patients — not just listed as available in a directory. "When people are trying to get an appointment with their primary care physician, they have to wait 30 days in some cases. If it's a specialist, they have to wait months," Ms. Guerraz said. "We hear from members — we do a lot of listening — and they'll say, well, your directory says that this doctor is seeing new patients, but we can't get an appointment for six months. Well, that's why we're doing this." e behavioral health gap For behavioral health, Ms. Guerraz was candid that access — not coverage — remains the core challenge, and that the fragmented nature of the behavioral health provider market makes it uniquely difficult to solve. "e biggest challenge is access," Ms. Guerraz said. "People have a very tough time getting access to and understanding, how much coverage do I have. And I think the biggest piece that's going to transform that in the rest of healthcare is when we get to a point where we're seamlessly exchanging data with providers — that's what's going to transform it, because that's a big hiccup in the system." To help bridge the gap in the near term, Aetna launched Mental Health on Demand this year — a virtual triage service that can provide members with real-time access to a licensed clinician through chat, phone, or video via the Aetna website. "It may not be the specialist you need long term, but at least it triages you to talk to a mental health expert, someone with a clinical background, to help facilitate where's the right place you need to go," Ms. Guerraz said. "I think that's very unique to behavioral health in this country." n "AI isn't about taking people's jobs — it's about augmenting people, the work that people do, and it's going to transform how people do their jobs and how we have to upskill them." — Katerina Guerraz, COO, Aetna

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