Our Take
The prior authorization metrics matter more than the earnings beat: 83% real-time processing and eliminating 1M provider calls shows actual operational progress in a broken system.
Why it matters
Healthcare AI practitioners need to track which insurers are actually automating approvals, not just promising to. Aetna's numbers provide a concrete baseline for what's possible in 2024.
Do this week
Health tech teams: benchmark your prior auth processing times against Aetna's 83% real-time rate before your next insurer partnership meeting.
Aetna operating income jumped 53% year-over-year
CVS Health's insurance segment Aetna reported adjusted operating income of $3.04 billion in Q1, up from $1.99 billion in the same quarter last year (per company earnings report). The 12.5% increase in the broader Health Care Benefits Segment was driven by improved performance in government business, including Medicare Advantage and managed Medicaid services.
Medical membership dropped to 26 million from 27.1 million year-over-year, attributed to CVS's decision to exit individual exchange business in 2026. The Medicare Advantage business benefited from CMS's decision to increase MA rates by 2.48% for 2027, compared to the initially proposed 0.09% increase. CMS said the final policies would raise insurer payments by over $13 billion in 2027 (per agency announcement).
Prior authorization automation shows measurable progress
Aetna approved more than 95% of eligible prior authorizations within 24 hours, processed 83% in real time, and eliminated over 1 million provider calls through automation and digital tools (company-reported). These metrics exceed industry commitments across all benchmarks, according to CVS.
The company joined other major insurers including UnitedHealthcare, Cigna, Elevance Health, and Humana in adopting standardized electronic prior authorization for common medical services like orthopedic surgeries and imaging. CVS also announced Health100, a health technology subsidiary using Google Cloud's AI for interoperability across payers, providers and pharmacies.
Track which insurers deliver on automation promises
CVS's prior authorization metrics provide concrete benchmarks for what major insurers can achieve with current technology. The 83% real-time processing rate and 95% within-24-hours approval rate set measurable standards for healthcare AI implementations.
Overall CVS revenue grew 6.2% year-over-year, with Health Care Benefits revenues rising to $36 billion from $35.8 billion. Pharmacy operations faced reimbursement pressure and weather disruptions, though underlying business performance exceeded expectations according to the company.