Issue link: https://beckershealthcare.uberflip.com/i/1546083
11 COO Inside Aetna's push to automate claims, upskill workers, reduce friction across healthcare By Scott King W hen Katerina Guerraz, Aetna's COO, stepped into her role in mid-2024, the company was having, by her own admission, a really tough year. Rather than look for incremental fixes, she and her team decided to set a new direction entirely — one focused on fundamentally redesigning how Aetna operates, not just for the company, but for the providers and members it serves. "We completely need a different north star — figure out how do we work differently with providers, how do we really design around the member experience, and then where can, how fast can we accelerate and apply technology for automation, and just have more smart workflows and streamline the work, not just for our constituents, but also for our colleagues," Ms. Guerraz told Becker's. "at's the big difference — how you apply this, so it actually makes the healthcare system better, simpler, and you take a lot of the friction out." e result is a sweeping operational push tackling claims processing, workforce training, provider relationships and member navigation — all connected by a single goal: taking friction out of the healthcare system. e push for real-time claims One of the most visible moves has been Aetna's second-generation claims assistant, designed to reduce the manual work that has long slowed claims processing and frustrated providers. It's a development Ms. Guerraz couldn't have predicted. "In my 30 years of healthcare — I actually started in clinical trials — I would never have thought we would be doing announcements on claims," Ms. Guerraz said. "But the reason that we did is because we're excited about it. If you think about health insurance and healthcare, there's still a lot of advancements that have happened, but not necessarily in the way of operations." e vision is straightforward: providers get accurate claims paid faster and members stop receiving explanation of benefits documents that don't make sense. But the longer-term north star is even more ambitious. At Aetna's first annual provider forum last year, attended by representatives from the top 30 health systems, Ms. Guerraz made a commitment that real-time payment needs to become the industry standard. "I didn't give a timeframe, but I said we need to get to a place in healthcare where we're doing real-time payment," Ms. Guerraz said. "Because when we eliminate rework, it's better for everyone – members, providers, and the healthcare system overall." AI fluency for every colleague Aetna currently handles 19 million provider calls a year. e goal is to go upstream — anticipating needs and surfacing information proactively so that many of those calls never need to happen in the first place. Alongside the technology investments, Aetna has launched an AI Academy across Aetna and CVS Health, designed to bring every colleague up to a baseline level of AI fluency — not just those in technical roles. "When we think about the future, 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," Ms. Guerraz said. "Our point of view in our company is that there is a basic level of AI that our colleagues are going to need, whether it's on the job or outside in their homes and in other parts of their lives." Image Credit: IIDE