From a fresh AI “front door” strategy to claims-integrity investing, CVS Health has spent the past few months signaling how it plans to grow.
Here’s a breakdown of CVS Health’s notable initiatives and developments since Oct. 1:
AI strategy unfolding
CVS Health unveiled an updated growth strategy and raised its 2025 financial guidance during its Dec. 9 Investor Day, including the introduction of a new AI-native consumer engagement platform designed to integrate services across its enterprise and partner organizations. CVS described the effort as an open platform anchored in a single app and built as an AI-native product. The company says the platform is designed to integrate experiences across its entities and external partners, with goals of simplifying care navigation, personalizing services, reducing costs and improving outcomes — building on AI capabilities already in place across its core businesses.
Also in December, CVS Health Ventures led a $35 million Series C funding round for Duluth, Ga.-based Codoxo, a company focused on generative AI-powered payment integrity. Echo Health Ventures joined the round as a new investor, alongside Sands Capital, 111 West Capital, Brewer Lane Ventures, Wipro Ventures, 450 Ventures and QED Investors. The funding brings Codoxo’s total raised to more than $75 million.
“Codoxo’s Point Zero approach and proven track record at national health plans position them uniquely to improve how payers ensure payment accuracy at scale,” said Justin Brock, partner at CVS Health Ventures. “We’re excited to support their mission to enhance payment integrity programs across the entire industry.”
Prior authorization reform
CVS Health reported progress on key affordability and access initiatives, including efforts to reduce prior authorization burdens and expand biosimilar adoption. The company said it has about half as many medical services subject to prior authorization as its nearest competitor, according to a Jan. 22 news release. CVS also said it approves more than 95% of eligible prior authorizations within 24 hours, including 77% of electronic requests in real time — a figure it projects will exceed 80% by year-end.
CVS added that it has embedded nurses in 17 major health systems to support discharge transitions, a program it expects will reduce 30-day readmissions and hospital stays by 5%.
Leadership moves
In January, Vijay Jun Patel was promoted to senior vice president at CVS Health and managing partner of CVS Health Ventures. Mr. Patel has been with the company since rejoining it in 2015. During his tenure, he has held roles spanning digital strategy, enterprise strategy, enterprise business development and the company’s COVID-19 task force.
Anticompetitive allegations
The House Judiciary Committee, in an interim staff report issued Jan. 21, accused CVS Health of restricting independent pharmacies from working with digital pharmacy competitors to protect its market position. The report — titled “When CVS Writes the Rules: How CVS Protects Itself From Innovation and Competition” — alleges CVS used its pharmacy benefit manager, CVS Caremark, to change network rules and issue cease-and-desist letters targeting pharmacies affiliated with hub-based digital pharmacy models. The committee said CVS’ actions may have violated antitrust laws and called for legislative reforms to address what it described as emerging anticompetitive behavior in the pharmaceutical supply chain.
Workforce shifts
In October, CVS Health opened a new Workforce Innovation and Talent Center and Community Resource Center in Fort Worth, Texas. The facilities, developed in collaboration with Fort Worth Housing Solutions, aim to build a pipeline of skilled healthcare professionals by offering no-cost training and services. CVS said the Workforce Innovation and Talent Center will provide hands-on training for positions such as pharmacy technicians, customer service associates and call center representatives in a simulated retail environment.
Also in October, CVS Health announced plans to lay off 72 employees tied to its Aetna business after the company was not selected for a new contract to support beneficiaries dually eligible for Medicare and Medicaid in Ohio. In a notice filed with the Connecticut Department of Labor, CVS said the job cuts are related to the Next Generation MyCare Ohio Program, which Aetna will no longer administer after the current contract ends.
Shuttered clinics
In October, CVS Health announced plans to close 16 Oak Street Health clinics, two years after acquiring the senior-focused primary care chain for $10.6 billion. CVS said the centers will close by the end of February, leaving 230 Oak Street Health clinics across 27 states. The company is scaling back after previously planning to open 300 locations serving older adults on Medicare.
“The move positions Oak Street Health for sustainable, long-term growth as we continue to navigate external challenges, such as elevated medical costs, CMS risk adjustment model changes and health plan payer dynamics,” a CVS spokesperson told Becker’s. “We continue to believe in Oak Street Health and its proven care model to deliver better clinical outcomes for our patients.”
