CVS Health (CVS) spends $ 20 billion over the next 10 years to upgrade to more technological experience in consumer health, a move that the company says will help to deal with rubbing in the problem health system in America.
The investment, Yahoo Finance, will not only affect the CVS and its vertically integrated enterprises, including the pharmacy, the suppliers of health and insurer Aetna. It will also allow competitors and other players in the sector to join the CVS system.
The CVS plan is based on an idea that has been the focus of a change in the sector for years: interoperability. This is the idea that all different parts of the system talk to each other, ideally through one patient record, regardless of the brand of the company.
Different administrations have tried to encourage the industry to do so over the years and a number of start -ups have tried to develop platforms to host such an environment. But everyone was unsuccessful for one key reason, said Tilak Mandadi, main experience and technology employee of CVS Health: companies do not want to shake things.
“Players who can really change healthcare are [incumbents]S People who have the range, size, scope and client platform and trust – who are ready to break, “he said.
Mandadi is charged with leading this change in CVS, one of the bigger players in the vertically integrated health space, with a market limit of $ 80 billion and an annual revenue of $ 373 billion in 2024.
Mandadi, who talks to Yahoo Finance today, resembles the current orchestra’s current health system, with each musician playing his own tune and the members of the audience trying to hold.
“It doesn’t work. Complaint # 1 of the clients is the health experience is not integrated,” he said.
The CVS project continues. But with a greater emphasis on the topic in recent months, such as fusion of factors, such as public impotence and federal government, aimed at health care costs, combined to create pressure to change. This includes the public reaction after the shooting of the Executive Director in December and the Trump enforcement order on the transparency of prices.
Mandadi said the company provides for a more active approach to healthcare, not patients who need to do all the research and make all the calls.
“Usually, health care is first to commit to the customer … And the health industry reacts reluctantly. We have to turn it to the head,” Mandadi said. “Experience should be proactive. And if we think the problems are being boiled, we must contact the user in the front.”
Mandadi said that if, for example, a claim is processed and a potential problem is placed with the request, the patient will also know instead of waiting to understand after being refused.
This would look like texts, calls or app notifications, but the user chooses to engage.
The goal of being upgraded also includes a dashboard for a patient to give doctors offices or pharmacies for CVS a complete picture of what is happening, not just the only reason for interaction, such as a visit or recipe.
Mandadi said that this opens more opportunity for patients to know more about their own health care.
Another key area that the investment in technology is directed is insurance claims and cost estimates. Currently, many insurers, including Aetna, have ways to evaluate the cost of their website or applications, but once again, it requires the patient to do homework and fact.
In order to achieve the goal of creating a more protective system, the company will need to lean on expansion of technology. But that doesn’t mean general system automation, Mandadi said.
“We have made some very explicit decisions [about AI]S No. 1, we will never use AI for a clinical diagnosis. # 2, we will never use AI in denials of all kinds. # 3, we will never use AI to prevent human touch in experience, “he said.
One way CVS already uses artificial intelligence is for calling to the pharmacy. If the patient needs an answer but is not able to contact a pharmacist and leave a voicemail, the voicemail is analyzed and can create a decision to implement. For example, if the patient wants to move to delivery, the system can process this from the voicemail.
Asked about confidentiality fears and lack of system to support systemic CVS, Mandadi said he believed patients would help change.
“Users are willing to share and give permission to reliable brands if that makes their experience much better. It’s quite well established. So I don’t think the users [are] The problem, ”he said.
But the regulatory environment needed to support the system will need inherited health players, federal and government governments, as well as participants in endeavors and private capital to come to the table and create the frame and funding to withstand such a huge project for all major companies, Mandadi said.
How CVS plans exactly all the components to achieve its ultimate goal is still in the process of working, but Mandadi says the plan can lead to significant changes in consumer health experience in just five years.
“I think healthcare needs an external prospect of what the experience should be,” he said.
It predicts the changes that CVS is planning and with other Legacy Player Buy-in, the US Health System can be processed.
“After five years, healthcare will be very significantly different in the United States. After 10 years it would be unrecognizable because of AI and technology,” he said.
Anjalee kachmli is a senior health reporter at Yahoo Finance, covering all things pharmacy, insurance, care care, digital health, PBM and health policy and policy. This includes GLP-1, of course. Follow anjalee as anjkhem on social media platforms X, LinkedIn and Bluesky @AnjkhemS
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