Aetna Pioneers Simplification of Prior Authorization Process to Enhance Healthcare Access

Aetna's Commitment to Simplifying Healthcare Access

In a landmark announcement made on June 23, 2025, Aetna, a subsidiary of CVS Health, declared its commitment to improving the healthcare experience through support for industry initiatives aimed at simplifying the prior authorization process. Aetna’s President, Steve Nelson, emphasized the need for the American healthcare system to work more efficiently for patients and physicians alike. The company is launching distinct strategies to navigate the complex healthcare landscape better, ultimately facilitating easier access to necessary care.

Aetna has already established a reputation for having one of the shortest lists of treatments requiring prior authorization in the industry. A remarkable 95% of eligible prior authorizations are completed within 24 hours, with some approvals finished in just a few hours. The company's initiatives signal a proactive approach to refining the healthcare process and reducing the upstream burdens on healthcare providers.

Bundling Prior Authorizations for Easier Processes

One of the significant changes Aetna is implementing involves bundling prior authorization requests. This innovative move is particularly aimed at patients battling serious conditions such as lung, breast, or prostate cancer. Instead of requiring multiple authorizations for associated imaging requests like MRIs or CT scans, Aetna will now consolidate these into a single approval. This change is set to roll out within the year and extends to adding further bundles for cardiology and musculoskeletal needs. This streamlined approach is expected to significantly alleviate the processes for thousands of members under Aetna’s Commercial and Medicare plans, as well as benefiting the medical professionals coordinating care.

Aetna Clinical Collaboration Program

In addition to making the authorization process simpler, Aetna has introduced a Clinical Collaboration (ACC) program designed to navigate care transitions effectively for patients transitioning between different healthcare settings. Aetna nurses are embedded within healthcare facilities, working in tandem with medical teams to ensure efficient patient transitions, whether moving from a hospital to home or into community care. The goal is to reduce 30-day hospital readmission rates and emergency room visits, contributing to better health outcomes for patients.

This hands-on involvement allows Aetna to develop personalized care plans tailored to meet individual health needs. By monitoring the entirety of a patient’s healthcare journey, including aspects such as medical, pharmacy, and mental health, Aetna can ensure continuity of care without service disruption once patients leave the hospital.

Advancing Digital Tools for Enhanced Patient Experience

Aetna is also placing considerable emphasis on technological advancements to improve the healthcare experience for its members. Recent enhancements to the Aetna Health app include features that provide real-time status updates on prior authorizations, making it easier for members to keep track of their healthcare needs without unnecessary delays. The app now includes a Smart Compare function which connects members with healthcare professionals who align with their health requirements and financial situations.

Members can also view status badges that display the progress of prior authorizations and gain insight into their coverage decisions. Such updates empower users by offering greater transparency over their healthcare journey, lessening the need to contact providers merely to check the status of their authorizations.

Aetna's Vision for a Transformed Healthcare System

In summary, Aetna is at the forefront of redefining the healthcare experience through continuous improvement strategies that prioritize the patient and provider experience. By reducing the complexity involved in navigating healthcare, the organization is allowing healthcare providers to focus more on patient care, minimizing administrative challenges and barriers.

As Aetna's initiatives evolve, they promise to transform the healthcare landscape, making it more accommodating for those it serves. This shift is fundamental in a century where accessibility to healthcare continues to be a paramount concern, ensuring that members have not only improved outcomes but also a smoother path toward achieving their health goals.

For more information about Aetna’s offerings and to keep up with the latest updates, visit Aetna.com.