The claim that all chronic care delivery will be miraculously transformed by the Anthem-CVS merger (and inevitable "me too" mergers between other drugstore chains/PBMs and other health insurers) requires a skeptical view.
I get the claim, that re-aligning the incentives in chronic care so that PBMs/drug stores are on the same side for chronic disease management and not in a war of treatment modalities will produce better chronic disease management. But, will it?
The way the story goes, diabetics will turn to (you guessed it!) CVS-branded minute clinics for diabetes management counseling, for example, and so have better cheaper access to this care. What kinds of things will be discussed in the counseling: diet? exercise? the risks of unmonitored polypharmacy? the need for group diabetes education and support, sometimes called diabetes self-management education?
Have the people proposing this ever even been to a CVS minute clinic? Continuity of care is not their watchword. Or, perhaps they are talking about the CVS minute clinic of the future, analogous to the CVS-V.A. alliances being piloted in Arizona or elsewhere, complete with electronic medical record information sharing.
In the meantime, minute clinics work on a business model that skims the easier less complex cases from primary care. These easier cases are the antithesis of the complex individualized analysis required for a diabetic not under tight control for example. Now, I know this is where CVS hopes to grow its business so that it can then also supply this population with all diabetes medications and testing materials.
But would the combined Anthem-CVS turn its CVS housed minute clinics into Diabetes diagnosis and prevention centers targeting the real challenges of individuals with diabetes in the community? After all, wouldn't that be what it would take to create those synergies of better chronic disease management for diabetes in the post-merger world?
Well, it depends on how the business would be structured and how the services would be reimbursed. Color me skeptical in a world where one of the newest CMS posted-regulations guts or undermines some of the most promising outcome-based bundled reimbursement experiments ever proposed.