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.
2 thoughts on “Anthem-CVS: What Would Consumers Get Out of It?”
In the meantime, minute clinics work on a business model that skims the easier less complex cases from primary care.
I wish it were that simple. In my part of the world (East Coast) our primary care doctors will send us to a pharmacy clinic when we cannot get an appointment with the pcp but do not have something serious enough to require an ER visit. The pharmacy clinic will do immunizations and has a lab tech to do blood draws. Is this better than having to schedule and drive to the doctor or the lab? Yes. Is this a big part of the delivery system? No.
I suspect the merger only matters if the combined organization can set up a more comprehensive network including doctors. Many have tried. It is not easy.
“What would consumers get out it”
Is that a trick question? How is that question even germane to a ‘leveraging the synergies disruptive game changing” deal?
Think of people as machines, then the whole IoT machine learning technology will monitor patients key life metrics continually through implants sold at CVS to pinpoint the EXACT moment that Aetna should cancel the policy to collect the maximum premiums before having to incur any claims cost. By using geofencing around every health facility on the globe Aetna will be able to send SMS messagesol to phone before theyj reach the facility to notify the would-be patient their coverage has been cancelled.
That’s the value consumers can expect cd.