Nikolas Kokovlis | Nurfoto | fake images
A version of this article first appeared in CNBC's Healthy Returns newsletter, bringing the latest healthcare news directly to your inbox. Subscribe here to receive future editions.
AHIP 2026 was held this week in Las Vegas, the annual conference organized by the country's leading health insurer trade association.
The two-day event included discussions that spanned the healthcare landscape, from new industry commitments on prior authorization and the growing role of AI to ongoing discussions about how to balance pharmaceutical innovation with affordability.
CVS Health spoke with CNBC about how the company is using artificial intelligence and other technologies to reduce administrative burdens and offer more personalized and proactive care experiences.
Below are some highlights from the conversation with Katerina Guerraz, chief operating officer of Aetna and president of Medicaid, and Tilak Mandadi, chief experience and technology officer at CVS Health.
Real-time data sharing could be a game-changer
Guerraz said some of the health system's biggest pain points could be easier to address in the coming years as insurers and providers work to reduce administrative burdens and share data more seamlessly.
He noted the industry's existing efforts to streamline prior authorization and other insurance processes, but said broader “interoperability” between payers, providers and other healthcare stakeholders could be “the biggest thing that will transform this industry” in the next three to five years.
“When someone who is in the healthcare ecosystem starts sharing data in real time, that really changes everything,” Guerraz told CNBC. “You don't go through all these different intermediaries of people processing different types of information.”
That could help patients access care faster, he added.
Conversational AI Tool Could Help Patients
CVS is betting that its AI conversational assistant, which launched in the fall on Aetna's website and mobile app, can help members navigate the health care system more easily by answering questions, anticipating needs and reducing the need for customer service calls.
The assistant is designed to go beyond the capabilities of traditional chatbots and automated phone systems, Mandadi said. Rather than simply answering a member's question, the tool aims to understand what the person is trying to achieve and guide them through the next steps. For example, a member asking if a surgery is covered could also receive information about expected out-of-pocket costs, prior authorization requirements and in-network care options, he added.
“We know why people call us most of the time. So how do we solve them and give them answers before they even have to reach out?” Mandadi said. “But if they do, conversational AI can do it the fastest.”
He said it's a proactive approach that gives members information before they even have to pick up the phone, and the company benefits too.
Mandadi said the company's pharmaceutical business previously received more than 500 million calls a year, many of which involved simple questions such as the status of a prescription. But today, about 75% of those interactions are resolved entirely through conversational AI, allowing pharmacists and customer service employees to focus on more complex issues, he said.
An AI personal assistant could anticipate patients' needs
CVS also envisions a future where patients can have a “persistent” AI personal assistant that actively manages and anticipates their needs in real time, Mandadi said.
That's a key feature of CVS and Google Cloud's Health100 platform, which will launch this year.
The AI assistant would monitor a member's clinical, pharmaceutical and insurance data and guide health decisions over time, he said. That tool goes beyond current chatbots: Mandadi described a consent-based system that maintains a continuous view of a member's health history, conditions, medications and benefits and uses that information to anticipate needs rather than simply answer questions.
It's another example of changing healthcare interactions from reactive to proactive, Mandadi said. Instead of waiting for members to call with questions or miss key steps in their care, the assistant would flag issues ahead of time and suggest follow-ups and recommendations in real time.
He said the goal is to reduce “healthcare tasks” that patients often have to do on their own, such as understanding benefits, managing chronic conditions or keeping track of appointments and medications.
The assistant could even detect early warning signs, such as missing medication refills or worsening health indicators, and intervene before they become more serious problems.
He said the system would eventually integrate multiple data sources, including claims data, pharmacy records, electronic medical records and potentially wearable devices, if patients consent.
Mandadi said the assistant could ultimately help patients achieve better health outcomes and reduce their out-of-pocket costs.
“That's the real beauty of it,” he said.
