Elizabeth Linthicum

Executive Director of Call Quality, Analytics and Customer Experience , CVS Aetna

CVS Aetna is a leading diversified healthcare benefits company, offering a broad range of health insurance plans, including commercial, Medicare, Medicaid, and specialty lines. With a customer base that spans tens of millions of members across the United States, CVS Aetna is committed to delivering high-quality, accessible, and customer-centric healthcare solutions.

Supernova Award Category: 
Next-Generation Customer Experience
The Problem: 

CVS Aetna’s contact center operations faced challenges – many of which are common to large healthcare providers: rising call volumes, seasonal surges requiring massive hiring, and the need to provide high-quality and consistent customer experiences across geographies. Moreover, the company aspired to improve its CMS Star Ratings for its Medicare plans – to safeguard billions in revenue. Legacy escalation models and knowledge access tools were failing to meet both agent and customer expectations.

The Solution: 

A comprehensive and systematic study of first call resolution and customer effort drivers is refining CVS Aetna’s service model for more proactive resolution strategies and empathetic interactions.

The company mines customer surveys, speech analytics, and escalations to uncover root causes of dissatisfaction from 17 million data points. This has directly contributed to revenue preservation initiatives, reclaiming critical CMS Star Ratings for Medicare plans, reversing a prior decline and safeguarding $8 billion in revenue.

Implementation of Iris, an AI-based knowledge management tool, helps agents navigate a labyrinth of information and protocols across myriad systems. Real-time coaching insights and a new enhanced mentorship program (AEP Heroes) improves agent experience. 

Supporting its offshore partners (approx. 60% of its workforce) with clear performance incentives tied to service quality has reduced labor costs while improving customer experience.

The Results: 

CVS Aetna’s customer experience trajectory has been fundamentally reshaped, and its Medicare Star Ratings have rebounded across its major plans. The company has seen dramatically improved call quality, accuracy and reduced handle times. Real-time coaching, training innovations, and an enhanced mentorship program are driving better customer outcomes and less agent turnover. A smart offshore strategy has created cultural alignment by incentivizing teams with performance-tied bonuses so that globally all resources are invested in achieving the same goals.

Today, the company is analyzing the tone, sentiment and outcomes of calls in real-time with AI coaching and CX and EX monitoring. Additionally, it is actioning 17 million pieces of solicited feedback from consumers annually through its customer experience management platform.

Metrics: 
  • CMS Star Ratings have been improved / restored across its major Medicare plans, preserving $8 billion in revenue.
  • Net Promoter Score has improved to mid-80s (Medicare/Medicaid) and ~75% (Commercial).
  • The company has commanded an impressive survey response rate ranging from 20 to 33% -- 10x above healthcare sector norms
  • Call handling times have been reduced by 5-10% and First Call Resolution has been improved by 2-5% across business lines.
  • Agent attrition for its Medicare business is down 10.6% YOY (though April of this year) as a result of the roll out of the new quality interventions, including its AEP Heroes mentorship program, Elevated Escalations Team, and call partner experience incentives.
  • Agent adoption of the Iris AI knowledge tool has gone from 14 to 60%, due to quality incentives, and education on impact and quality coaching.
The Technology: 

These are the key technology solutions driving CVS Aetna’s customer experience success, along with its Iris proprietary AI-powered knowledge management platform (developed internally):   

CVS Aetna is using Verint Speech Analytics, the Verint CX/EX Scoring Bot, Verint Automated Quality Management, and the Five9 cloud contact center. It is also using Medallia as its customer experience management platform.

Disruptive Factor: 

CVS acquired Aetna for $69 billion in 2018, making it one of the largest healthcare mergers in history.

Given the many communities the company serves and the touchpoints maintained throughout the care journey, it believes it has a unique opportunity to strengthen trust in medicine and health care.

Through a culture of listening, iteration, and precision interventions, Beth has built a new benchmark for how healthcare organizations can scale to serve while improving both the agent and the customer experience and optimizing customer relationships and the delivery of care. This is capitalizing on the power of insights and feedback from an organization the scale of CVS Aetna for competitive advantage.  

Shining Moment: 

Beth has championed her team to push the envelope to use technology in innovative ways to meet the company’s business objectives. She calls her teammates her “magicians.”

CVS Aetna’s contact center operations are focused on taking ownership and accountability, doing the right actions, and demonstrating empathy to build trust.

“Be real, be authentic. Be anti-transactional and more relational”; these are the overarching goals for CVS Aetna’s customer service. This is why its technology must be purposeful in ensuring that interactions are not only accurate and expedient, but that they are infused with genuine empathy and concern. 

About CVS Aetna

CVS Health® is a leading health solutions company building a world of health around every consumer, wherever they are. As of December 31, 2024, the Company had more than 9,000 retail pharmacy locations, more than 1,000 walk-in and primary care medical clinics, a leading pharmacy benefits manager with approximately 90 million plan members, and a dedicated senior pharmacy care business serving more than 800,000 patients per year. The Company also serves an estimated more than 36 million people through traditional, voluntary and consumer-directed health insurance products and related services, including highly rated Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company’s integrated model uses personalized, technology driven services to connect people to simply better health, increasing access to quality care, delivering better outcomes, and lowering overall costs.