There’s “a hunger for a different kind of dialogue” when it comes to relations between payers and providers, according to Aetna President Steve Nelson.
Mr. Nelson laid out a vision for Aetna that centers on rebuilding trust in the industry, an effort he said is already producing measurable results with some of the country’s largest health systems and that informed Aetna’s recognition as Press Ganey’s inaugural health plan of the year earlier this month.
“I can tell you firsthand that the provider community and provider organizations wake up every day trying to do good work. And so do payers,” Mr. Nelson told Becker’s. “I think if we can start with positive intent and change the dialogue — if we can focus on the patient and the member as opposed to our own issues — we end up in a better place.”
Mr. Nelson, who took the helm at Aetna in late 2024 after leading UnitedHealthcare and value-based primary care company ChenMed, said the insurer’s strategy rests on three themes: better navigation to help members move through a complex system, an advocacy mindset that treats member interactions as more than transactions, and stronger partnerships with providers.
That last theme, he said, is one the industry needs to focus on getting right. The payer-provider dynamic “has not always been super constructive,” Mr. Nelson said, “and that needs to change. This idea that we can’t work together is not true.”
The push to improve relations comes as network contracting disputes between insurers and health systems have become increasingly public and contentious, with 171 disputes reported in traditional media in 2025, up from 51 in 2022, according to FTI Consulting.
In one example Mr. Nelson shared, a health system told Aetna that its speed in processing prior authorizations was actually creating problems, asking the insurer to slow down on those decisions.
“They said, ‘I know you guys take great pride in approving care quickly, sometimes in real time, but we find there’s a lot of denials associated with incomplete data. If you would actually hold off on making a determination for 48 hours, we think we would reduce the number of denials and a lot of rework and friction,'” he said.
Aetna agreed to the 48-hour hold and said it reduced denials and resubmissions by 80%.
“That’s something that happened simply because we started a better dialogue,” Mr. Nelson said. “When we see the friction and see the data points, we go have direct conversations.”
Aetna has been part of the Press Ganey HX Exchange since 2023, a collaboration that bridges patient experience data from provider systems with member experience metrics. That program, along with the broader provider engagement work, informed Press Ganey’s decision to recognize Aetna with the new award.
Earlier this year, Aetna’s parent company CVS Health said it now approves more than 95% of eligible prior authorizations within 24 hours, with 77% of electronic requests processed in real time. Still, patients and providers continue to report burdensome delays and denials surrounding the process, and Mr. Nelson acknowledged more work needs to be done.
“There’s a constant tension between clinicians and payment,” he said. “We’re in a tight funding environment with historically high year-over-year trends and high healthcare costs.”
In December, Aetna shared that it has bundled pharmacy prescriptions and medical procedures into a single clinical review for complex diagnoses. Mr. Nelson pointed to oncology as an example, where a cancer patient previously needed separate authorizations for drugs, surgical procedures and imaging, often from multiple prescribers. Aetna now processes those as a single authorization. The change also eliminated a second review that had previously been required on the specialty pharmacy side under Caremark.
“[The provider] delivers great quality care, we’ve been with you long enough, we have enough data — a lot of prior authorization can be eliminated,” he said. “That’s when you start getting into a real seamless experience.”
Over the last year, Aetna has announced investments in AI-powered navigation tools, new digital features like Care Paths, and the expansion of a care coordination program that aims to reduce hospital readmissions for its Medicare Advantage members.
Mr. Nelson said sustaining that shift in how the company engages with providers is what drives him currently.
“My strong passion right now is to change the dialogue between payers and providers,” he said. “We have got to create a different approach, because the finger pointing isn’t working, and it just leaves members in a bad place.”
