Aetna第三季度提供方调查：支付方信任评分6.0分，94%受访者称欺诈是医疗系统必须解决的问题
CVS Health（纽约证券交易所：CVS）旗下安泰（Aetna）10月26日在康涅狄格州哈特福德发布第三季度「Aetna 医疗服务提供方调查」结果：医疗支付方与提供方之间的平均信任评分为6.0分（满分10分），与第二季度的6.1分基本持平，高于第一季度的5.4分。这项季度调查由决策情报公司 Morning Consult 执行，样本为727名美国医疗服务提供方，整体误差幅度为正负4个百分点。
调查显示，提供方对支付方的评价在多项指标上维持了上半年的改善。50%的受访提供方表示，支付方作出的决定以患者福祉为优先，较第二季度上升2个百分点、较第一季度上升6个百分点。52%的受访者认为支付方一贯兑现承诺，56%认为支付方提供的信息清晰易懂，两项数据均与第二季度持平。
CVS Health 执行副总裁兼 Aetna 总裁 Steve Nelson 表示：「建立信任仍然是我们的首要任务，我很高兴看到支付方与提供方之间的信任评分保持强劲。深化与提供方的关系，有助于我们密切合作，提高可负担医疗的可及性，也让会员更容易使用医疗系统。」他同时表示，公司仍有更多工作要做，但对提供方认可 Aetna 在减少摩擦、提高透明度方面的投入感到鼓舞。
行政负担仍是提供方的主要挑战，但压力有所缓解。67%的受访提供方将行政负担列为当前首要挑战，较第二季度下降7个百分点。在将行政负担列为首要挑战的受访者中，27%认为事先授权是主要成因，低于第二季度的31%；58%则认为更新患者病历是最大成因，上升5个百分点。被问及支付方最能帮助他们应对挑战的行动时，近三分之一的受访提供方选择「提供实时患者信息」，为得票最高的选项。
在欺诈、浪费与滥用议题上，94%的受访提供方认为这是医疗系统需要解决的问题。近60%的受访者认为，解决这一问题最大的好处是降低医疗系统的整体成本；57%估计，欺诈、浪费与滥用每年给系统造成约1,000亿至4,990亿美元的损失。约30%的受访者建议支付方使用人工智能（AI）标记可疑理赔或模式，这是他们最推荐的行动。近九成受访者认为，支付方每年切实可减少多达一半的欺诈、浪费与滥用，约90%认为 AI 已经在帮助解决这一问题。
「Aetna 医疗服务提供方调查」为季度研究，向美国医疗服务提供方市场征询其对支付方与行业的看法，受访者包括医院系统高管、医生、护士、药剂师以及医疗信息技术负责人。Aetna 为约3,700万人提供健康保险产品与相关服务；CVS Health 截至2026年6月30日约有9,000家零售药房门店、1,000多家步入式与初级医疗诊所，其药房福利管理服务覆盖约8,700万计划成员。
Aetna Q3 Provider Survey: Trust Score Holds at 6.0 as 94% of Providers Call Fraud a Problem the System Must Address
Aetna, a CVS Health company (NYSE: CVS), announced findings from its third-quarter Aetna Provider Survey in Hartford, Connecticut, on October 26: the average payer-provider trust score was 6.0 on a scale of 1 to 10, in line with the 6.1 reported in the second quarter and up from 5.4 in the first quarter. The quarterly study was conducted by Morning Consult and polled a representative sample of 727 U.S. providers, with an overall margin of error of plus or minus four percentage points.
Providers said payers sustained improvements in several areas during the third quarter. Fifty percent of providers said payers make decisions that prioritize patient well-being, an increase of two percentage points from the second quarter and six points from the first. Fifty-two percent said payers consistently deliver on their promises, and 56% said payers provide clear, understandable information, both unchanged from the second quarter.
"Building trust remains our priority, and I am pleased to see the payer-provider trust scores remain strong. Deepening our provider relationships helps us partner closely to improve access to affordable care and makes it easier for members to navigate the health care system," said Steve Nelson, Executive Vice President of CVS Health and President of Aetna. He added that more work remains, but that he is encouraged providers are recognizing Aetna's investments to reduce friction and improve transparency.
Administrative burden remains a significant but improving challenge. Sixty-seven percent of providers identified it as their top challenge, down seven percentage points from the second quarter. Among providers who cited administrative burden as a top challenge, 27% named prior authorization as the leading contributor, down from 31% in the second quarter, while 58% named updating patient medical records as the single biggest contributor, up five points. Asked for the most important action payers could take, nearly one in three providers chose providing real-time patient information, the top answer.
Nearly all providers, 94%, agreed that fraud, waste and abuse is a problem the health care system needs to address. Close to 60% said the top benefit of addressing it is lowering overall costs in the health care system, and 57% estimated that fraud, waste and abuse cost the system about $100 billion to $499 billion annually. About 30% of providers said they want payers to use artificial intelligence to flag suspicious claims or patterns, their top recommended action. Nearly nine in 10 believe payers can realistically reduce up to half of fraud, waste and abuse each year, and about 90% believe AI is already helping to solve the issue.
The Aetna Provider Survey is a quarterly study of the U.S. provider market, whose respondents include hospital system executives, physicians, nurses, pharmacists and health IT leaders. Aetna serves an estimated 37 million people with health insurance products and related services. As of June 30, 2026, CVS Health had approximately 9,000 retail pharmacy locations, more than 1,000 walk-in and primary care medical clinics, and a pharmacy benefits manager with approximately 87 million plan members.
来源：GSM·美国（原文链接）
图片来源：图：CVS 药房门店外观。照片：deathpallie325，CC BY-SA 4.0，经维基共享资源。 / A CVS Pharmacy storefront. Photo: deathpallie325, CC BY-SA 4.0, via Wikimedia Commons.
