6 ways that CVS's purchase of Aetna could affect you
Over the weekend, CVS made headlines by announcing that it would be acquiring health insurance company Aetna for $69 billion. In a statement on Sunday, CVS CEO Larry Merlo described the merger as one intended to “create a health care platform built around individuals” through the combined company, which stands to serve as “America’s front door to quality health care.”
But what does this actually mean for consumers, and what can CVS customers and those insured through Aetna as well as those insured through other insurance companies expect when it comes to their everyday lives? Here are a few things we see on the horizon:
1. A different model of health care.
Samuel Richardson, a health economist and associate professor of economics at Boston College, tells Yahoo Lifestyle that first and foremost, the CVS-Aetna merger is about combining different parts of the health-care supply chain.
Richardson explains that the CVS-Aetna deal is in some ways similar to what already exists with the care consortium Kaiser Permanente. In the Kaiser model, Kaiser is the health insurance company, owns the hospitals, pays the doctors’ salaries, and owns the pharmacies. It offers, in effect, a completely “in-house” model of health care consumption, where all aspects of its members’ health care experience are holistically integrated into one system and, often, one building.
“If I had a crystal ball, my expectation is that CVS is taking one more step toward being like Kaiser,” Richardson says, pointing to CVS’s early moves in this direction by the company’s acquisition of the pharmacy benefits manager (PBM) Caremark in 2006 — thus offering its own in-house mail-order prescription fulfillment services in addition to the standard practice — and the announcement of its decision to stop selling cigarettes in 2014. Both moves indicate a serious commitment to being thought of as a health care provider, first and foremost.
“If I had to guess, I would think their next big move would be to look for a big hospital chain to acquire and try to do a Kaiser model,” says Richardson. “Kaiser is very successful where it’s established but not successful in expanding beyond its geographic strongholds because it’s a hard thing to do in a new market. It’s hard to expand every part of the health care supply chain in every aspect in a new market. It’s a really hard model to expand geographically. But CVS is already everywhere. Aetna is already a national insurance company. And they’re seeing this as, ‘OK, we can build up from the parts we have everywhere to try to build this other model.’”
2. We might eventually be going to the doctor at the pharmacy.
Richardson notes that the CVS-Aetna merger indicates a larger trend in the American health care marketplace of “moving toward a system where you’re getting your primary care in the same place where the pharmacy is and integrating all those pieces together.”
And it’s a model proven to work by CVS, where consumers can already utilize the brand’s MinuteClinics to see midlevel providers, such as nurse practitioners, about routine ailments and preventive care.
“From my perspective as a health economist, this can only be good,” Richardson says. “The primary care shortage we’re experiencing in America isn’t about training more physicians in primary care, but letting other health care professionals [such as nurse practitioners and physician assistants] practice up to the limits of their training.”
3. Other big pharmacies might follow suit.
“I would watch Walgreens very carefully,” Richardson says. “I would not be surprised to see talks between Walgreens and another big health insurance company like Anthem or Humana” in response to the CVS-Aetna merger, he says.
“If someone is going to the doctor, or the nurse, at a MinuteClinic, it’s very convenient to go in the same building to pick up your prescription,” he emphasizes. Which is why it wouldn’t be unexpected to see other companies jump on the same model of care.
That said, Richardson adds, “I hesitate to oversell this. This is a good model for low-grade things like, ‘I have a fever and do I have strep throat?’ This is a place for routine things that you would go to a primary care physician for, and now there’s an alternative. But I don’t think CVS is going to have your cardiologist right there or a hospital onsite everywhere. You’re going to have MinuteClinics all over the place, but for more serious things, you’re still going to need to go elsewhere.”
4. Easier, more convenient access to care.
Richardson emphasizes that historically, health care has been anything but a consumer-focused industry; for one thing, many physicians’ offices are only open Monday through Friday during standard business hours — a model that is far from friendly to the majority of people who need health care. The CVS-Aetna merger, however, indicates a move away from this standard to something more user-friendly, whereby consumers can walk into a MinuteClinic during extended hours and access preventive care.
“I see this as CVS trying to have this be the normal model for how people have their first interaction if they need preventive care in the health care system,” Richardson says. “They’re going to have much more of a focus for consumers where you can just walk in and be seen, or you can use the CVS app and see if there is an appointment available at a location near you. It’s going to be far more convenient for people to make that first contact with the health care system,” Richardson says.
Which isn’t to say that CVS won’t still be a place where customers can pop in to pick up toilet paper, milk, and mascara. Now, says Richardson, it just might also increasingly be a place where you can not only “pop in if you’re feeling ill, but pop in to say, ‘Is this something I need treatment for?’ This is having in some sense a convenience-store approach to a person’s initial contact with the health care system, where it’s easy and quick to just go in and say, ‘Hey I want to see a nurse to check out this issue.’”
That said, Richardson says this shift in models isn’t likely to result in more cost savings to the health care system as a whole, as those with chronic and more serious conditions will still be utilizing more traditional avenues for access — and courses of treatment with much higher costs than that of a round of antibiotics.
“This may lead to better access to care for a lot of people, but it’s not a cost-saving measure for the system as a whole.”
5. Possible conflicts of interest.
Some experts fear that the CVS-Aetna deal might also lead to significant conflicts of interest that could prove less than beneficial for consumers.
Robert Berenson, a fellow at the Urban Institute and an expert on health care delivery issues, says there are still many questions to be answered about what the merger looks like in implementation for consumers.
“Is Aetna going to restrict choices and somehow incentivize people to go to” CVS MinuteClinics, Berenson asks. “Will these CVS centers also be available for patients with other insurers?”
6. Cheaper prescription drugs — for some.
Berenson also speculates that the clout of CVS and Aetna joining forces means that CVS’s pharmacy benefits manager product, Caremark, might have more clout in negotiating lower drug prices for its customers from the pharmaceutical companies.
“If Aetna is able to get CVS to be more aggressive at getting lower prices from the drug manufacturers, this is conceivably possible,” Berenson says. “But I don’t know why you need a merger to do this. Maybe being larger just increases the leverage they stand to have over the pharmaceutical companies.”
A lot remains to be seen when it comes to what benefits, and cost savings, will come to whom and when. For now, however, Americans can expect to see how their health care might become more accessible and more cost-efficient, and how other players in the marketplace are prompted to react in response.
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