5 Ways the CVS + Aetna Deal Will Change Health Care Delivery

Griffin Mulcahey December 8, 2017
5 Ways the CVS + Aetna Deal Will Change Health Care Delivery

This week, CVS and insurer Aetna announced what would be the largest health care transaction to date, if approved by regulators and shareholders. The companies agreed that CVS will take over Aetna, with the No. 3 U.S. health insurer becoming a stand-alone unit inside the pharmacy giant.

The companies laid out the vision for how the combined entity could reshape care delivery. A health care system where CVS’s MinuteClinic retail clinics become the entry point of health care. This shift, if successful, will dramatically change health care in 5 key ways:

1. Walk-in clinics as the quarterback of health care decisions

Health care has grappled with guiding consumers to change the default settings for initial health care diagnosis and treatment. In reality, when someone is sick or injured they go where they can get care immediately - emergency rooms, freestanding emergency rooms and urgent care facilities. Locations that cost the consumer and insurers the most.

2. Drive real consumer choices in a world of expanding high deductible plans

40%+ of US insured patients are now on high deductible plans. The dream of high deductible insurance was to give consumers skin in the game, incentive their own wallets to make more affordable health care choices. In reality, this theory has proven woefully wrong. People do not price shop, or negotiate. They go where they think they can get better, fast (see #1). By making a local walk-in clinic the first stop, CVS can nudge consumers to the most affordable options for the next steps in their treatment, like the best price for a MRI, or the more affordable specialist in the area with great outcome scores.

3. Care team management for chronic conditions

Chronic conditions represent healthcare the Pareto principle (also know as the 80/20 rule law). 86% of health care spending is attributed to people with multiple chronic conditions. One of the biggest drivers for improving outcomes among chronic patients is medication adherence and regular contact with the patient’s care team. CVS will have all pharmaceutical data as the benefits manager, and a nurse practitioner or dietitian that knows the patient’s history on site. Imagine, a patient walks into CVS to purchase cough drops and the cashier directs them to the clinic to discuss their health and remind them they did not fill up a prescription that was due for a refill 3 days earlier.

4. Reduce costly and unnecessary hospitalizations

This is driven by the implications of 1, 2 and 3 above. If someone goes to an emergency room they are more likely to be admitted than a patient who went to a clinic setting (#1). If a consumer doesn’t know a procedure could be performed cheaply in an outpatient setting they may go to a hospital instead (#2). And If patient’s who fail to manage chronic conditions represent a massive proportion of preventable hospitalizations (#3).

5. More flexible employment options for front-line clinicians

The often overlooked factor in health care, how will this impact the doctors, nurse practitioners, physician assistants, and support staff that deliver health care every day? CVS may expand the over 1,100 minute-clinics to over 4,000 clinics in the coming years. For nurse practitioners and physician assistants, this means a massive increase in jobs and responsibility as quarterback of health care decision making. For doctors, this likely translates to a significant increase in telehealth delivery in order to drive smarter utilization of specialist care while avoiding expensive hospital based care delivery.

Through their $69 billion deal, CVS Health and Aetna are reimagining the traditional ways in which patients access health care in hopes of building a new cary delivery approach with lower cost and more convenience for the consumer.

Health care front-line clinicians - doctors, nurse practitioners, and PAs, will also have to reimagine their career options based on the seismic shift.