Aetna's AI-driven cost estimator now covers 20,000 services.
Usage has jumped from below 10% to nearly 70%.
This shows a focus on member experience over traditional insurer metrics.
What happened
Aetna, the health benefits business of CVS Health, has rebuilt its cost-estimation product to cover more than 20,000 medical services, allowing members to use natural language and AI to estimate costs before receiving care.
Why it matters
This shift has led to a major behavioral change: usage of the cost-estimation tool has risen from below 10% to nearly 70% among people using the capability before a procedure, reflecting a focus on member experience over traditional insurer priorities.
What to watch
The test is whether these tools actually shift care patterns, not just member satisfaction, with Aetna’s success hinging on measurable outcomes like fewer ER visits. Watch whether adoption holds near the nearly 70% usage rate before procedures.
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Aetna's technology strategy, led by Nathan Frank, has centered on member experience rather than the industry's traditional focus on utilization and cost management. The company rebuilt its cost-estimation product to cover more than 20,000 medical services, a move that has driven usage from below 10% to nearly 70%. This indicates that providing clear cost information before care can significantly change consumer behavior, potentially leading to better preventative care and fewer unnecessary emergency visits.
The success of this initiative is tied to a unified data foundation developed during the pandemic, including an enterprise data platform and a Clinical Data Repository. These investments enable Aetna to connect digital interactions to care costs and health outcomes, evaluating products beyond conventional metrics. Frank's goal is to make healthcare feel like a connected journey across coverage, pharmacy, and care, reducing the 'homework' assigned to consumers.
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