When Steve Nelson was hired to lead Aetna in November 2024, he had his work cut out for him. The nation’s third largest commercial health insurance provider had brought down the total earnings of parent company CVS Health as care costs skyrocketed. In its mid-2024 earnings report, year-over-year operating income for the health benefits portion of the business was down 39.1%. Nelson, as executive vice president of CVS Health and President of Aetna, was part of a slate of new leadership brought in by then-new CEO David Joyner for a comprehensive turnaround.

A year and a half later, the story has changed significantly. In its most recent earnings report last month, CVS’s profits hit $2.9 billion, with a 52.6% year-over-year increase in adjusted operating income in Aetna’s health care benefits segment.

This edition of the Forbes CEO newsletter will focus on how Nelson has been able to bring about this turnaround at Aetna, his strategies for success and outlook for the future.

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Redefining Purpose Culture

Nelson’s first changes at Aetna were less about healthcare or insurance, and had more to do with the business itself.

When he started, Nelson said he noticed deep credibility and trust issues from all sides: shareholders, government and private clients, and employees themselves. Skyrocketing costs, leadership changes and a precarious market had made many people wary of the company. Even people who worked for Aetna, Nelson said, seemed to be wondering if what they were doing actually mattered.

So he doubled down on the reason Aetna exists and its purpose: The company started more than 200 years ago as a fire insurance provider named after Sicily’s active volcano Mt. Etna.

“Fires and calamities and things will come, but the mountain stays strong,” Nelson said. “That’s the legacy that we’re leaning into: Resilience.”

He also set clear priorities for the company, rebuilding a culture that had been lost through difficult times and leadership changes. He brought together a team of advocates for a transformational culture, and they helped open the lines of communication between leaders and employees. Nelson said the strong communication fostered an environment of “relentless execution,” rejuvenating the company from within.

Another opportunity that Nelson noticed—along with Joyner and other new leaders at CVS Health—the entire company wasn’t always operating as a complete unit. Nelson said he’s been leaning into the enterprise aspect of CVS Health—which includes the pharmacy, pharmacy benefit manager Caremark, and primary care provider network for Medicare patients Oak Street Health. Nelson said this also drove a unified company-wide culture and a meaningful increase in worker engagement.

“In the last 18 months or so,........

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