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Analysis

CVS-Aetna Aims to Complement Health Systems, Says Chief Digital Officer

By Mandy Roth  
   November 19, 2018

Aetna executive delivers straight talk about competition, opportunities, and the evolution of digital technology.

Digital technologies are changing the healthcare experience and the way consumers interact with health systems and providers. Payers, like Aetna, are also impacted by this dynamic. The looming merger between Aetna and CVS Health presents new opportunities for digital strategies that not only empower consumers, but also provide better ways to gather data to improve health outcomes.

What can health systems learn from an entity that already has connections with 22.1 million members in its medical plans (as of June 30) and will have the chance to build millions more through those who patronize CVS and its 1,100 MinuteClinic retail clinics, which some predict may evolve into full service urgent and primary care facilities? I spoke with Aetna’s chief digital officer Firdaus Bhathena about these topics and the role digital technology will play in the future of healthcare.

Bhathena shares how CVS health hubs will support, rather than compete, with physicians and health systems; how their member app uses AI, deep learning, and geo-sensing to help consumers make better choices to reduce costs; as well as the greatest barrier digital healthcare developers must overcome. 

Before joining Aetna in 2016, Bhathena was an outsider to the healthcare industry, spending much of the previous two decades building and launching technology startups. He holds master's and bachelor's degrees in electrical engineering and computer science from Massachusetts Institute of Technology.

The following transcript has been lightly edited.

HealthLeaders: Describe Aetna's digital health strategy.

Firdaus Bhathena: We want to be the best in the world at leveraging technologies for healthcare; that is our guiding principle. We don't have to invent all of it; we don't have to be the ones doing a lot of the fundamental research on it. We realize this is a very big space, and we can't do it all. What does it mean to be the best in the world at that?

  • AI is going to play a big role in healthcare. It already is, and it's going to accelerate in the future.
     
  • Connected device integration is going to be a big deal.
     
  • Being able to engage in virtual care, coupled with the physical presence that we will uniquely have once the CVS acquisition closes, is another critical element.

[Our strategy] is certainly not digital only, but it's digital-first in a tiered model that leverages technology like artificial intelligence, machine learning, and deep learning to deliver insights that can then translate into virtual consultations or virtual care, and then can then translate into in-person care, as needed. That's kind of the tiered approach that we're talking about.

HL: With the CVS merger, if you start delivering care, you begin competing with the providers you currently work with. Digital plays a role in making that happen. Can you address that?

Bhathena: That's actually a very interesting question. Let me make it personal. My wife has been a pediatrician for 25 years. When I say to her, "[Aetna's] going to be creating these health hubs when we get together with CVS, and CVS is already trialing some of these, is that threatening? Is that competitive with you?"

I bet the reaction I get is very typical of what most primary care physicians would say. [She says], "We would love it if we had a one-stop shop for people to go to, to take care of a lot of the day-to-day necessities that end up filling our days, and we get paid very little for. [Those activities] take us away from spending time with the patients who need us the most." The system just does not give them the freedom to do that today.

I really think that [one-stop shop] is a model that can work extremely well. It's not just me, [many] of us here believe that far from being competitive, it will create an ecosystem of support around physicians who will deeply appreciate the fact that they are now empowered to focus on the things that they believe is their primary mission and what they trained for… If 95% of your day is filled with the mundane, it becomes less interesting after a while. You're not having the impact you think you can have on the lives of the patients who need you most.

HL: What opportunities do you think the merger with CVS might provide in the digital realm?

Bhathena: You must have heard the phrase that all healthcare is local? It's all about people and engaging with people. CVS has a tremendous advantage in that a large percentage of the U.S. population is within a reasonable driving distance of a CVS pharmacy or store. That gives us a local presence that pretty much nobody else has. If you combine that with a digital ecosystem that's with you all the time—in your pocket or on your wrist—we complement that local physical presence with a digital presence that can help guide you, not just when you are sick or when you have a particular episode, but throughout your life. That's what we're aspiring to do.

HL: Consumer-driven dynamics are prompting health systems to transform their approach to care. How are these same dynamics impacting the payer market?

Bhathena: Who is more motivated to lower the cost of healthcare than [payers] are? Nobody. Consumers would like the costs to go down only in the case where they're actually paying for it. If we are going to have more high-deductible health plans, which puts responsibility in the hands of consumers, then it is our obligation to give them the information and tools to enable them to make those decisions well. No one is more incentivized than payers to give consumers high-quality information at the right place at the right time to make the right decision for themselves.

Imagine if [a member] went into a mammogram facility and the digital app on her phone [used geo-sensing capabilities to] proactively notify her that she's in a facility that is not in network? [That upgrade to our app] is probably about six months out. This is the kind of stuff we're working on—how we can inject ourselves in this process without being intrusive or annoying but being a helpful partner.

HL: Can you share other examples of where you're pushing the digital envelope?

Bhathena: When I joined [Aetna], I came from outside the healthcare industry. People said to me, "One of the most important things we need to do is to give our members pricing about medical procedures." That made a lot of sense. I thought, "How hard can it be?" Boy, was I wrong!

It feels like there are tens of thousands of CPT codes. How doctors use different codes affects the ultimate bill. That makes it really hard to come up with an accurate price. The old mechanism to do that was [estimates based on a set of codes that the physician might use.]

We built a machine-learning model that uses deep learning and statistical modeling across the historical record of billing from that particular provider to give you a much more accurate, much-closer-to-reality estimate of what it's going to cost you.

The system we have can actually tell you if you have your procedure here, it's going to cost you X amount; if you go down the street half a mile and get it done at another facility, it's going to cost you this much less. Now, the decision is yours. The consumer feels you were transparent, and you intervened before it was too late. That AI-powered, cost transparency solution is in the [Aetna member] app that's available today. Like all machine learning–driven systems, it gets better with time.

HL: What can hospitals and health systems learn from Aetna's experience?

Bhathena: Because of Aetna's focus on well-being, one of the things I've learned is that being well is not the same thing as not being physically sick. When people think about health and healthcare, the definition of what that means is increasing pretty dramatically.

One of the biggest learnings we got from the [Health Ambitions Study that we released this year—a survey exploring consumers’ health goals] is that consumers are becoming way more conscious about nontraditional determinants of health that are not adequately addressed today. Behavioral health and mental health issues are huge. [The survey indicates] discussing health goals and general health questions don't seem to be reasons people feel like they can speak with a doctor. Most people are just going there for an annual checkup.

I don't think that's the future of healthcare. I think the future of healthcare is combining thoughtful assessments of how people are doing in different parts of their life—not only their physical health, but emotional health, social connectedness, financial security, purpose, and character strengths. We have what we think is a pretty groundbreaking partnership with the Harvard [T.H. Chan] School of Public Health to address all of those six dimensions that come together to define how you feel as a person.

HL: What role does digital play in that?

Bhathena: In the early days of this, most of the research has been around asking people how they feel and how their lives are, and being very smart, and thoughtful, and careful about the kinds of questions asked. This is kind of what the Harvard School of Public health helps us with. Increasingly, that's going to shift to the digital realm where more and more of what we know about people—and this has to be done carefully and with the right privacy and security constraints in place—is going to come from connected devices. Digital is the primary mode by which we can collect data from people directly via these thoughtful assessments and connected devices. More of the insights that are derived from this vast amount of data we get is going to be done by deep learning systems.

HL: Where do you think the greatest challenges lie in moving digital strategies forward?

Bhathena: The challenge really lies in the fundamental trust that needs to exist for people to be willing to make data about themselves available. Ultimately, the value they get from it will be huge. There's a lot of concern around privacy [regarding] what can you do with this data in the future.

The same information that can be used to do a lot of good, could also potentially be used to harm somebody. As we go forward, it is upon us in the technology world to build systems that give people a sense of confidence and trust that [they will derive value without a] potential downside. So in one word, I think the biggest challenge here is trust.

Mandy Roth is the innovations editor at HealthLeaders.

Photo credit: iStock Photo


KEY TAKEAWAYS

Rather than competing with primary care practitioners, in-store CVS "health hubs" will create an ecosystem of support, freeing physicians to focus on patients who need them most.

Forthcoming app upgrade will contain geo-sensing capabilities to warn members if they enter an out-of-network medical facility.

Aetna's app uses machine learning to predict costs based on a provider's historical billing record.

Building consumer trust is the biggest challenge to future digital strategies.


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