Health Insurance: Changing Healthcare with Aetna (CXOTalk #317)
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Health Insurance: Changing Healthcare with Aetna (CXOTalk #317)

The healthcare system, it definitely needs
to change. What’s the role of the insurers in that system? Today, on CXOTalk, we’re speaking with someone
who is driving change at a major healthcare insurer. I’m Michael Krigsman. I’m an industry analyst and the host of CXOTalk. I want to give a huge shout out to IPsoft. We are in their AI Experience Lab in the heart
of the financial district in New York City. IPsoft is making CXOTalk possible today. Now, before we go any further, tell your friends,
tell your family, subscribe on YouTube. We’re speaking with David Edelman, who is
the chief marketing officer of Aetna. Hey, David, how are you? I’m doing great, Michael. Thank you. Welcome back to CXOTalk. Thank you. A pleasure to be here again. David, I have to say congratulations, first
off, because once again you were selected as one of the most influential CMOs in the
world by Forbes. Congrats on that. Thank you, and thank you to my team because,
without them, none of that would have happened. It’s terrific to have such a great team. David, you’re CMO at Aetna. Tell us about Aetna, your size, your focus. I think everybody knows the Aetna brand but
tell us about Aetna and tell us about your role. Sure. Aetna is actually a 165-year-old company,
incredible heritage, focused on all different kinds of insurance starting with fire insurance,
originally, and moving through and now focusing purely on the healthcare space. We have dedicated ourselves in healthcare
to change the way insurance companies work with people to manage their overall health
needs. I’ll be talking about that as we go forward
in our discussion. David, I think we should begin healthcare. Why is healthcare so complex? Healthcare is complicated because there are
so many different parties. They are not very well connected. The payment mechanisms are convoluted, and
it’s very hard to assess what is quality, what is a good outcome. And so, you don’t really know what you pay
for. How many times do you actually decide, “Okay. I’m going to buy this. I don’t really know how much it’s going to
cost. I don’t really know how good it’s going to
be. I’m going to take it home and then, three
weeks later, I’m going to get a bill”? That’s the way healthcare works. It’s quite convoluted because of the way the
whole system has been set up. That leads to disincentives to really manage
that as a tight system that’s focused on helping keep people healthy at the most efficient
cost. When you say that there are disincentives,
can elaborate on that? It seems like a root issue that’s going on
here. Well, if you pay people in the healthcare
system based on what they do, there’s an incentive to do — to actually generate action in order
to get paid. That is not necessarily what people need. It could lead to excess costs. It also doesn’t create a lot of incentives
for different parties to work together to create a total outcome. One of the biggest problems — frankly, this
is a problem in many businesses, in general, it’s a problem in healthcare writ large — is
that every different component is optimized for just that component. When you see a doctor, that doctor is focused
on that visit. In the lab, they are just focused on trying
to take care of whatever they have to do in terms of drawing blood and doing the results. But, there’s not necessarily a connection
that’s saying, “Well, we’ve got to get this back as fast as possible because it’s under
these circumstances.” Things like that aren’t necessarily inherently
linked to the system when you have all different parties all the way through. And so, you have people going into this system
who don’t really know how to stitch it all together. That’s challenging to people, especially if
they’re facing complex situations. You have numerous parties, each of which is
optimizing for their own narrow set of outcomes without looking at the broader patient wellness? Is that an accurate way of describing it? It is and, frankly, at the highest level,
it just simply operates like a warranty card system because it’s only helping you when
you’re sick. It’s like you have insurance, which is, okay,
when I get broken, I need you to pay for fixing that. But, shouldn’t we try to keep people healthy
in the first place? The system isn’t really geared to that. The system is geared towards taking care of
you when things go wrong. That leads to people entering the system when
they’ve got more and more problems. We should see somebody entering the clinical
system as an example of when we haven’t done our job in terms of keeping them healthy. Preventive maintenance is ultimately a key
driver of the kind of outcomes with healthcare that we want. Definitely. If you look at the different drivers of what
contributes to longevity, things like your genetics, the healthcare that you get, that
actually contributes less than 50% to people’s outcomes in terms of longevity of life. Some of the biggest ones are your own behaviors. Forty-percent of your outcomes are based on
the things you do. Fifteen percent are based on where you live
and the conditions in your community. If we can work on those, we can keep people
out of the clinical system way more often and have better impact, healthier people,
lower cost, but it’s a challenge to put it all together to make that happen. All right, so now you have this objective,
and you have this strategy. How do you go about making this change, because
it requires a change in mindsets and goals inside Aetna but, at the same time, it requires
changing perceptions on the part of consumers? As you put right at the beginning of this
conversation, you are part of a larger system of many different components, and so how do
you change your role? There are many different components to it. It’s not a simple two-step process. One key part right at the beginning was, within
Aetna, changing our sense of mission at the individual employee level, giving them a deep
sense of where we’re going. We did a lot of research with consumers. We came out of that research with a very clear
sense that they want the support, that there’s an opportunity to help them with their health
care and, in doing so, help them with their lives because it’s not just about fixing things. It’s about the joy of life. We’ve used that as a platform to come up with
the whole new relaunch of our brand. In 2017, we completely rethought and launched
a new brand positioning. Aetna: You don’t join us; we join you. We join you. We are about helping you realize the joy of
achieving your health ambitions. We changed, also, all of the ways we communicated
with people, our photograph, even our typeface, our language. As we started making those changes and communicating
it through the organization, people got incredibly energized about being a part of this. We join you. That’s just such a sense of mission. It also put a stake in the ground that this
is where we’re heading and we’re not turning back. There was a fear. Are we getting ahead of ourselves in doing
that? But, the sense was, we have to. We have no choice. We have to make it clear this is where we’re
heading. With that stake in the ground, behind that,
we’re also making a lot of investments in customer experience improvements. We’re really digging into what happens as
people flow through the health care system to come up with whole new designs of offerings
such as I described before to support people with breast cancer. We’re going through all the different things
that we do and starting to look at them from a member point of view in a more integrated
way. That takes work. That’s hard. We’re a company of 50,000 people scattered
all across the country, many different functions that have to work together. In marketing, we’ve set up now an office of
the consumer that is our kind of guiding energy that looks across, looks at the metrics, helps
bring up all of the issues where things are falling through the cracks or where there
are opportunities. Through that, it’s the spark that initiates
new work to start changing those aspects of the experience. As we can build the experiences and deliver
against them, plus communicate and reinforce what we’re doing with the messages of our
brand, we can start to change the perception, get more engagement, and build that trust. The brand encapsulates the set of goals that
you were just describing. But, behind that, it sounds like there’s a
great deal of process change. There are new ways that you’re interacting
with your members. There’s a lot behind it, so it’s not just
a veneer. It’s not a veneer. Let me give you another very good example. There are a lot of different things that actually
come together when you get health insurance. You may have not just basic medical. You may have dental, vision, pharmacy benefits,
and all of those may be coming from Aetna. Originally, you would get, upon becoming a
member, five different welcome packages for each of those different lines of insurance. We’ve stepped back and said, “Okay. That makes no sense,” first of all from a
cost perspective, but also from an experience perspective. We’ve changed the onboarding process to provide
people with personalized videos that give them, when they join, a completely integrated
picture of all the services they have with links to wherever they can get help on different
aspects of it, making sure that they’re way better educated on what they have and how
to get the most out of it. Through that, we’ve simplified it. It’s a lot less overwhelming. We have better-educated members. It’s a four-minute video. We’re getting 70% completion rates on that
video. That’s unheard of for a four-minute video. People are engaging in this, and we can start
to see the value as we hit different parts of the experience like that. Where are you in the process of rolling this
out? Well, this has many different pieces to it. We have launched the brand. It has rolled through all aspects of our communication. We have over 3,000 different touchpoints,
potentially, with our members: different emails, print, many different kinds of online touchpoints. We’ve been working through rearchitecting
those. We’ve also been changing the materials we
use to communicate with employers, with doctors, with different parties through whom we do
business because we’re in the middle of a lot of different constituencies. We’ve worked through most of that at this
point. We’ve been making changes to the customer
experience already. There’s still technology things that have
to come into place. There are even more tests we have to do to
figure out what works and what doesn’t. We’ve started. We’re about two years into it. It’s a multiyear journey. Along the way, there’s so much still to learn. One of the aspects, for example, of what we’re
doing is we have these pods where we are testing different ways of helping people understand
what better behaviors could mean for them: getting a flu shot, not having to necessarily
go to an emergency room for a head cold. We know what we want to do, but we don’t know
what’s going to work. We don’t know what’s going to work for different
populations, so we’ve got to test and learn and test and learn and set up things like
that in order to figure out the best way to work with our members and connect with them. There’s still a lot to build. There’s still a lot of learning along the
way, but we’re on our way. You mentioned measurement. Can you describe some of the measurements
that you look at as you’re evaluating this overall program that you’ve been describing? There are different kinds of measures across
different things we’re doing. From just a very higher funnel perspective,
looking at people’s acceptance of us, do they think of us as a health partner? Do they trust us? We are measuring that, and we’re seeing gains,
especially in the markets where we’ve launched the new brand and we’ve also doubled down
in extra support in those markets. We measure customer satisfaction overall,
as I cited earlier, which has been going in the right direction. Then we also look at, most importantly, outcomes
— outcomes, which is related to reducing medical costs per member. You’ve got to put those all together. Of course, there are extraneous things that
happen like the flu and things like that that throw a wrench into some of the measures. Basically, when you look at trendline and
the things that we have been doing and the impact, it’s all going in the right direction. We’re seeing that. The Medicare Star’s data is a great example
of that. When you say outcomes, what are the outcomes
to which you’re referring? We’re looking at positive outcomes: so, things
like lower readmissions for things; so fewer ER visits; things that are positive health
outcomes from people who have had some kind of interaction that they needed to have with
the healthcare system. But also, just frankly, overall, trying to
keep people out of the healthcare system if they don’t need it, not artificially, but
trying to keep them healthier. Now, ideally, we’d love to measure something
we call healthy days. For all of our members, was today a healthy
day? Try to keep track of it. We’ve tried that. It’s a hard measure to do consistently at
scale. We’re still trying to figure out how we might
be able to tie something like that to a hard, quantitative number. I know for a while you had a program where
you were encouraging your members to get an Apple Watch because that contributes to wellness
because they’re own heart rate and so forth. Mm-hmm. Is that part of this kind of program that
you’ve just been describing? Well, we still have the Apple program, and
there’ll be more news about that in the future. Now, where does CVS fit into this picture? The theory behind merging with CVS is that,
through the CVS network that’s out there, which is an incredible network of health professionals,
pharmacists, Minute Clinics, we can provide much better access to people. We can provide them with new kinds of support
for services that they can get right nearby from licensed healthcare professionals. Pharmacists are the most trusted healthcare
professional, actually. Is that really true? Yes, and they are probably, for most people,
the healthcare professional you see the most. Ultimately, what CVS offers is a front door
to support in the community, right there in the local market. They are a place where members can get support
for what will be an increasing range of needs that we can support them with. I’m assuming that the idea here is to take
health care out of the hospital and move it increasingly closer to the patient, to the
member. And, ultimately, into the home, if it’s appropriate. For many people, going into their homes is
something that actually makes a huge difference. I’ll give you an example. We have a service called Aetna Community Care
which, for our highest risk patients where people do have real issues, it goes into people’s
homes and looks at their situation to help figure out how we can help them. For example, one patient who had serious asthma,
many emergency room visits, you go into the home and you see shag carpets all over the
place. That’s catching dust, and that’s something
that is contributing to somebody’s asthma. By working on things like changing the carpets
and actually investing in changing those carpets on our part and helping the member, we can
dramatically decrease their emergency room visits. But, you would never know that without going
into the home. Ultimately, bringing it from the exam table
to the kitchen table, coming way down into each individual, whatever their relevant world
is, will make a bigger difference in terms of their health. If you look at the person as a whole–their
lifestyle, their environment, their context in every way–then you will be able to do
a better job to be a partner, as you were describing, in making whatever adjustments
might be necessary so that they don’t get sick, don’t end up in the healthcare system. Right. Obviously, that’s going to be better for the
patient, and it will be better economically for you. And, at the same time, it will engender trust
on the part of the patient towards you. Then, by extension, on the part of the broader
health care system and towards Aetna as well. Does that summarize it? [Laughter]
[Laughter] That summarizes it extremely well, Michael. I think you got it. Where is all this going? Where it’s going is, it’s a continuing journey
on our part. Where it’s going is, we are extending into
more clinical situations of trying to figure out the right way, similar to breast cancer,
similar to asthma, maternity, different ones, what is the right way to support people throughout
an entire journey, especially way at the beginning to make sure they get off on the right foot. It’s about making sure our processes internally
are not thinking about just one little step along the way. It’s not enough to make sure people are happy
with what happened when they called into the call center. Why did they call in the first place? People don’t want to call. What’s the issue there? Let’s make sure we’re actually mitigating
the reasons to call in the first place, upfront, through better education when they first become
a member. There is all of that kind of diagnosis, which
we’re just talking to more and more aspects of the health experience, more lines of business
within Aetna. We’re also ramping up more of our content
creation, being able to have more and different ways that we can provide education and inspiration. We’re ramping up our behavior change pods
where we can test and learn. It’s really now, frankly, about scaling. It’s about learning. But, it’s also about continuing a pretty major
change process within our company. What’s the hardest part about all of this? What you’re describing, changing any aspect
of our healthcare system seems like almost an impossibility, so what’s the hardest part? The hardest part, well, there are several. There are several things. One is sequencing, where to start, how to
think about the right steps along the way because there’s so much we can do, so many
different aspects of what we can hit that we’ve got to figure out how to prioritize. Different parts of our company have their
sense of what they think the priorities are, and so how to allocate. We don’t have unlimited investment money,
so how to allocate that is a challenge. Right at the beginning is how to set the priorities
and allocate the capital. That’s certainly one. The second is figuring out how to change long,
established processes where even the computer systems, everything underlying those was tuned
to a world that’s changing. We’re going through moving a lot of our systems
from very legacy architectures into cloud-based systems. That’s not a simple thing, but we’re, again,
figuring out which ones to do when and how to sequence that. We also, challenging wise, have to think about
the right way to communicate with all of our different constituencies, be they employers,
be they members, also brokers who help employers figure out what insurance they should have. We’re trying to change the buying criteria
from what it had traditionally been, and plenty of employers get it, but you have distribution
channels who you also have to work through in order to get to those sponsors, in many
cases, and so we’ve got to work with them. There are a lot of different marketing challenges
in all of that, but that’s what makes it exciting. Also out there in the system, you have embedded
financial incentives that I would think also militate against any type of change, whether
that change is going to ultimately save money or benefit the consumer or not. There are, but there is a recognition that
this is not sustainable. The pressure, especially from the government,
in terms of the rising cost of Medicare and Medicaid and the pressure from employers to
lower the costs and have better outcomes because, from an employer’s standpoint, it’s not just
an issue of cost. It’s also an issue of productivity. If they have healthier employees, they’re
more productive. That’s even more valuable, in many cases,
than the cost of the care. There’s pressure to work on this, and so we’ve
got to respond to that. The parties are realizing that. There’s clearly competition in terms of jockeying
for a position up and down the value chain to do that, but there is a sense that something
has got to move. Okay, David Edelman. Thank you so much. My pleasure. Thank you, Michael. We have been speaking with David Edelman,
who is the chief marketing officer at Aetna. Now, once again, don’t forget to subscribe
on YouTube. Thanks so much, everybody. Have a great day.

About Bill McCormick

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2 thoughts on “Health Insurance: Changing Healthcare with Aetna (CXOTalk #317)

  1. Aetna has screwed me so bad over the last two years it's not even funny. I was eligible for a new electric wheelchair two years ago and they refused to even talk to me. Mine broke down completely over a year ago and they have not crap. I also have to take medicine for blood clots for the rest of my life because of how they handled my care after surgery two years ago. Stay away from them. There is another video on here by CNN and an investigation on them. My insurance is a union plan mhbp that I've had since 1981. They were great for 35 years and now they are crap. Buyer beware!! Rich πŸ‘ŽπŸ‘ŽπŸ‘ŽπŸ‘ŽπŸ‘ŽπŸ˜­πŸ˜­πŸ˜­πŸ˜­πŸ˜­πŸ˜¬πŸ˜¬πŸ˜¬πŸ˜¬

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