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.
Robert Glazer, MPA, CEO of ENT and Allergy Associates in New York, has, for a number of years, encouraged otolaryngologists to build relationships with local pharmacies to bolster referrals, and sees the merger as yet another sign that otolaryngology practices need to boost connections to grow and sustain their practices. Given that clinics such as Minute Clinics increasingly are providing accessible frontline care, he encouraged otolaryngologists to check in monthly with these types of clinics to cultivate referral sources.
Both Glazer and Dr. Setzen used the word “gatekeeper” to describe the role of Aetna/CVS in this new model of healthcare delivery. “I think [Aetna and CVS] are going to completely retool to be the gatekeeper of the entry level access to the healthcare system,” said Dr. Setzen.
For Glazer, this role by a major drug store is not without snags. “I think a merger where a drugstore chain is a gatekeeper for medicine will result in these companies steering patients to drug formularies that are more profitable for these companies,” he said.
Impact on Patients
How this merger and others like it will affect patients is yet to be determined; however, there is little doubt that the easier access and convenience of care offered by facilities such as Minute Clinics will be well received by patients, said Dr. Setzen.
In addition, he emphasized that moving care out of hospitals into ambulatory and outpatient settings, and now Minute Clinics, may “really open up the discussion about cost of healthcare, variation in quality, and transparency as to services provided and the cost of those services.”
Dr. Sun cited arguments in support of these discussions. “It has been proposed that the merger may make it easier for Aetna/CVS to monitor and encourage regular, appropriate use of prescription medications for chronic diseases, which in turn may lead to reduced beneficiary hospitalizations, emergency room visits, and other adverse outcomes, thus improving health and saving money.”
He was quick to point out, though, that evidence of other merged healthcare entities and integrated health networks show an ambiguous track record, at best, of cost containment. “Therefore, the positive and negative effects of such an unprecedented merger in the healthcare arena are difficult to predict,” he added.