The recent merger between Aetna and CVS unites one of the largest insurance companies with a major retail pharmacy, and opens the door to transforming how healthcare is delivered in the United States.
Whether this move will ultimately be good for patients remains unknown, but speculation on the potential upsides and downsides of this type of merger within the U.S. healthcare industry is taking shape as other similar mergers promise to emerge. Just days after the announcement of the Aetna/CVS merger, U.S. insurance giant UnitedHealth announced plans to acquire DaVita Medical Group, which operates approximately 300 clinics, urgent care centers, and outpatient surgery centers in a number of states.
New Models of Care
In an article published Dec. 5, 2017 in the Harvard Business Review, John Toussaint, MD, CEO of Catalysis, an integrated health system based in Wisconsin, described how these kinds of mergers are upending the way healthcare traditionally has been delivered in the U.S. by offering a new model that prioritizes access to care and lowers costs by moving the delivery of care out of the hospital setting.
In the Aetna/CVS model, delivery of care will be offered through the CVS Minute Clinics, which currently number more than 1,000 nationwide. These clinics resemble an amalgam of urgent care and preventive/primary care, said Gordon Sun, MD, MS, medical director of inpatient services and chief of otolaryngology and ophthalmology at Rancho Los Amigos National Rehabilitation Center in Downey, Calif, who added that the vision of healthcare delivery outlined by Aetna and CVS is to eventually evolve into offering “wellness” centers that, among other services, will provide core clinical care, including vision and hearing health, as well as pharmacy and medical equipment.
Impact on Otolaryngology
Whether this type of model will be competitive or complementary to the more traditional physician-led or hospital-led model is not known, but Dr. Sun said that specialists will likely see changes to their practices. “Otolaryngology, like many specialties, will likely experience more indirect downstream effects, such as changes in availability and cost of commonly prescribed medications,” he said.
Gavin Setzen, MD, president of the American Academy of Otolaryngology–Head and Neck Surgery, also sees potential changes to otolaryngology practices, particularly those practices that offer basic services for common issues such as ear infections, tonsillitis, nose bleeds, and pediatric services. “If these types of services are diverted to Minute Clinics, then you may see a shift in referral patterns that may require realignment of physician practices with better relationships with these kinds of entities,” he said.