AHIP 2026 took place recently in Las Vegas. This annual conference is hosted by major health insurance associations in the country.
The two-day gathering included various discussions about healthcare initiatives, covering topics from new pre-authorization processes to the increasing importance of AI. There was also a focus on finding the right balance between innovation and healthcare affordability.
A highlight was a conversation between Katerina Guerraz of Aetna and Tilak Mandadi from CVS Health, discussing how technology can ease administrative challenges and enhance personalized care.
Guerraz mentioned that addressing key issues in the healthcare system might become easier in the near future as insurers and providers prioritize reducing administrative burdens while improving data sharing.
She referenced current efforts to simplify prior authorization and suggested that “interoperability” among payers and providers could significantly transform the industry over the next three to five years.
“Sharing data in real-time within the health ecosystem changes everything,” Guerraz noted. “It eliminates the need to navigate through various intermediaries.” This could ultimately enable patients to receive treatments more promptly.
CVS has introduced a conversational AI assistant, which was launched in the fall with Aetna’s website and mobile app, aimed at helping users better navigate healthcare by responding to inquiries and anticipating needs, thereby reducing the volume of customer service calls.
Mandadi emphasized that this assistant goes beyond traditional chatbots. It aims to understand a member’s goals instead of simply answering questions. For instance, if a member wants to know if their surgery is covered, they also receive details about potential out-of-pocket costs and other relevant information.
“We’ve identified typical reasons for calls—so how can we provide answers before the call happens?” Mandadi explained. “Conversational AI can support that faster.”
He pointed out that it’s a proactive strategy that yields beneficial outcomes for both members and the company. With over 500 million calls concerning simple inquiries like prescription statuses annually, Mandadi noted that about 75% of these interactions now can be resolved by conversational AI, allowing staff to concentrate on more complicated cases.
CVS also imagines a scenario where patients have a “persistent” AI assistant that actively identifies and manages their needs in real time, according to Mandadi.
This will be a central feature of the upcoming Health100 platform from CVS and Google Cloud, set to debut this year.
This AI assistant will manage a variety of data, including insurance, pharmacy, and clinical information, to assist in health decisions over time. Mandadi mentioned that it is a consent-based model, designed to capture health history and related information, not just to answer questions, but also to predict needs.
The intention here is to shift from reactive to proactive medical interactions. Instead of waiting for patients to reach out with queries or to follow up on care steps, the assistant could highlight potential issues and provide recommendations in real time.
Another goal is to make it easier for patients to navigate their “medical homework”—you know, understanding their benefits, managing chronic conditions, and keeping appointments. This assistant would also help catch early warning signs, such as missed medication refills or concerning health changes, to intervene before they escalate.
If patients provide consent, this system could eventually incorporate multiple data sources like claims records and even info from wearable devices.
Mandadi believes this capability could significantly enhance health outcomes while minimizing out-of-pocket costs for patients. “That’s genuinely the promise of this initiative,” he commented.
