At Aetna's headquarters in Hartford, Connecticut, healthcare consumers face a troubling reality that would be unthinkable in most other sectors: they often commit to services without understanding the costs involved, juggle information between separate organizations, and typically handle the coordination of their own care. Nathan Frank, serving as the Chief Digital and Technology Officer of Aetna, has prioritized the removal of these obstacles in his technology strategy.
As a division of CVS Health, Aetna contributed to the impressive revenue of $402.1 billion in 2025. Within CVS Health’s Health Care Benefits category, Aetna generated $143.4 billion and catered to 26.6 million medical members at the end of the year. Leading a team of about 6,000 technology professionals, Frank oversees thousands of platforms encompassing experiences for members, providers, and colleagues, while also focusing on platform modernization and the integration of artificial intelligence.
Frank’s vision is refreshingly straightforward. He noted, “No other industry asks customers to do homework.” Historically, healthcare has centered around payers, providers, and systems rather than the consumer experience. His objective is to leverage technology to create a seamless experience for coverage, pharmacy, and care as interconnected elements of one journey.
Transforming Transparency into Valuable Insights
When Frank took on the role of technology leader at Aetna roughly four years ago, he diverged from industry colleagues focused on cost containment and cloud migration. Instead, he honed in on enhancing the member experience. Aetna revamped its cost-estimation tool, now accommodating over 20,000 medical services. Thanks to natural language processing and AI, members can assess the costs of various procedures before they receive care.
This revamp has dramatically shifted member engagement. Usage rates climbed from below 10% in the previous system to nearly 70% among users utilizing the feature pre-procedure. "It’s outrageous to commit to a service without a clear cost estimate," Frank remarked.
Aetna assesses these innovations using more than just conventional customer satisfaction metrics. Their teams employ A/B testing and link digital interactions with proactive engagement strategies to evaluate impacts on preventive care access, emergency room avoidance, and the need for more complex interventions.
Harnessing AI on a Unified Data Framework
Frank’s ambitious plans rely on a foundational strategy initiated well before the rise of generative AI as a focal point. During the pandemic, CVS Health developed a comprehensive data platform to consolidate information from across the company, ensuring it’s usable throughout an individual’s healthcare experience. Additionally, they invested in a Clinical Data Repository to streamline clinical information for sharing with providers and other stakeholders.
“You wouldn't see the advancements we're achieving with AI and machine learning without having your data structured appropriately,” Frank pointed out. This groundwork facilitates use cases focused on enhancing human interactions rather than replacing them.
One compelling example involves Aetna's care management team, which includes over 15,000 nurses. Previously, nurses preparing to speak with members facing serious diagnoses had to sift through various systems and extensive clinical documentation. AI now helps summarize case notes ahead of discussions, utilizes ambient listening during interactions, and organizes information post-interaction, giving nurses an extra 90 minutes each day to dedicate to patient care. “It’s not about reducing our workforce,” Frank clarified, “but about enabling our nurses to engage more meaningfully with patients.”
Shifting from Reactive Coverage to Proactive Healthcare
Aetna is also leveraging data and digital tools to foresee member needs. Their next-best-action capabilities encourage individuals to arrange vaccinations and preventive appointments. Aetna was the first insurance provider to implement Rich Communication Services, replacing standard SMS texts with interactive, engaging experiences that allow members to access information and locate providers through their preferred messaging platforms.
Frank noted that engagement with RCS messaging has surpassed 80%, significantly outperforming traditional SMS opt-out rates. The company tracks whether these interactions lead to preventive care and ultimately minimize complex health interventions. This strategy merges Aetna's data insights, solid member relationships, and user-friendly digital experiences to create more beneficial outreach, going beyond mere frequency.
Trust is the key factor shaping the pace at which Aetna progresses. With over 3,000 data scientists and a long-standing commitment to machine learning and responsible AI practices, every AI initiative undergoes rigorous governance to ensure privacy, security, and transparency. "AI is here to enhance our relationship with members," Frank stated. "Our focus is on ensuring it’s used appropriately and transparently."
Empowering Change through Collaboration
Frank's operational model embodies this principle. Engineers, technology product managers, and business product managers collaborate closely, involving nurses, care managers, and service staff in the development process. Integrating continuous feedback into product design enables teams to monitor usage and refine solutions on a near-daily basis.
Looking forward, Frank anticipates that advancements in AI and real-time data integration will transform consumer experiences, clinical care approaches, and operational efficiency while reducing administrative costs. The ultimate goal is a healthcare system that proactively identifies and addresses chronic or acute conditions rather than merely reacting when they arise. "That’s our mission," he emphasized, "to help individuals lead better lives and spend less time navigating the healthcare system."
