Health Insurance:
Changing Healthcare with Aetna

Michael Krigsman: 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.

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We're speaking with David Edelman, who is the chief marketing officer of Aetna. Hey, David, how are you?

David Edelman: I'm doing great, Michael. Thank you.

Michael Krigsman: Welcome back to CXOTalk.

David Edelman: Thank you. A pleasure to be here again.

Michael Krigsman: 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.

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: 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.

Michael Krigsman: David, I think we should begin healthcare. Why is healthcare so complex?

David Edelman: 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.

Michael Krigsman: When you say that there are disincentives, can elaborate on that? It seems like a root issue that's going on here.

David Edelman: 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.

Michael Krigsman: 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?

David Edelman: 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.

Michael Krigsman: Preventive maintenance is ultimately a key driver of the kind of outcomes with healthcare that we want.

David Edelman: 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.

Michael Krigsman: 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?

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: 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.

Michael Krigsman: Where are you in the process of rolling this out?

David Edelman: 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.

Michael Krigsman: 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?

David Edelman: 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.

Michael Krigsman: When you say outcomes, what are the outcomes to which you're referring?

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: Mm-hmm.

Michael Krigsman: Is that part of this kind of program that you've just been describing?

David Edelman: Well, we still have the Apple program, and there'll be more news about that in the future.

Michael Krigsman: Now, where does CVS fit into this picture?

David Edelman: 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.

Michael Krigsman: Is that really true?

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: Right.

Michael Krigsman: 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]

David Edelman: [Laughter] That summarizes it extremely well, Michael. I think you got it.

Michael Krigsman: Where is all this going?

David Edelman: 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.

Michael Krigsman: 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?

David Edelman: 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.

Michael Krigsman: 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.

David Edelman: 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.

Michael Krigsman: Okay, David Edelman. Thank you so much.

David Edelman: My pleasure. Thank you, Michael.

Michael Krigsman: 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.