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If the CVS-Aetna deal is allowed, what next?

Uncertainty. The adage, “May you live in interesting times” seems apt.

CVS Health Corp.’s decision to purchase Aetna, announced in December, represents the latest example of rapid innovation in the health-care world, and it’s one that will affect both physicians and patients. Referral-driven ophthalmology can expect to feel the winds of change. While it is unclear whether this merger of the pharmacy giant and the health insurer will be financially compelling in the near term, its potential implications should be positive for every health-care consumer, including eye-care patients.

My company, Everseat, has gained a wide-angle view of US health care via our cloud-based scheduling software. Thousands of providers currently use it, including those in value-based practice models. These providers are motivated to direct patients with nonacute issues to qualified lower-cost care resources such as physician assistants, nurse practitioners and technologies facilitating lower cost care such as TeleHealth. Further, our many ophthalmology clients give us a perspective on the competitive landscape for patient acquisition and retention.

Here are our eight predictions for the months and years ahead.

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1. The tipping point has been reached.

We expect more nontraditional combinations such as this one to emerge. Rising health-care costs, variable quality and largely stagnant wages1 are all factors leading health-care constituents to demand more of the system. Innovative providers are reacting. If approved by regulators, the combined CVS-Aetna entity will be a new animal. Managed-care organization? Drug store? Pharmacy benefits manager? Primary care location? The dynamics of the U.S. health-care system have reached a tipping point across many facets.

2. More disruption is coming to health care.

We’ve heard for months that Amazon is working on a plan to disrupt the pharmacy space. But Amazon is not the only company. A major, yet somewhat quieter disruptor, is UnitedHealth. Today, UnitedHealth offers many ancillary care management services via its substantial Optum subsidiary. Its recent acquisition of DaVita Medical Group adds 2,200 additional clinicians to its already large provider-footprint of 250 urgent care facilities, 200+ ambulatory surgery centers, and 30,000 partnered, contracted and employed physicians.2 Next up: Humana and Walmart may seek to expand their already close relationship.

3. Count on a broader menu of in-store care.

Primary care and flu shots are just the beginning. Access will be easy — to the tune of 9,700 stores with approximately 1,100 clinics.3 We expect to see a much wider range of provided services including allergy testing, blood tests and lab work, eye care, hearing, nutrition, imaging, even quick in-office procedures.

4. Another catalyst for price transparency.

When Jane Q. Public enters a CVS to buy a headache remedy, she has numerous options and visible price-points. This is true for most products and services, but not in health care. The combined CVS-Aetna merger, however, could push such transparency into the fringes of outpatient health. It’s hard to imagine consumers not demanding the same visibility in other delivery settings.

5. Consumers will look at health care more positively.

Interacting with the health-care system is often a hassle. It begins with scheduling a visit, then often extends to long waits and a lack of communication between patient and doctor. A more easy-to-schedule location with posted prices will do wonders for consumers and the health-care experience. Crucial primary and preventive care could flourish under a new CVS-Aetna roof.

6. A variety of channels serves as an antidote to doctor shortages.

Access to care continues to widen. In addition to telehealth’s growing role, we also expect to see more mobile health units, vans, house calls and other channels. CVS has the trifecta with care delivery, insurance and pharmacy benefits management. We see other innovators jumping into the “traditional doctor appointment” space and touting their ability to address the perceived lack of supply of primary care doctors — as forecast in 2016 by the Association of American Medical Colleges.5

7. Referral patterns are now at risk.

Here’s where ophthalmology will directly feel the change. The provider inside the CVS store will have tremendous control over where patients are sent for specialty visits. Larry Merlo, CVS Health president and CEO, has commented that the combined company could become “America’s front door to quality health care.”6 Front door indeed. CVS will likely treat those it can in-store and refer those patients who need specialty care to CVS’ own network of preferred providers — perhaps those who accept Aetna?

And it’s not just ophthalmology that will feel the impact — think about cardiology, orthopedics, neurology, dermatology, gastroenterology, women’s health and pulmonology. How these specialists maintain a direct line with CVS will prove to be important. Will CVS employ optometrists and drive referrals of cataract, LASIK and retina appointments to ophthalmology offices? We didn’t think Walmart and Target would impact things — and now Walmart alone has 3,000 vision centers in its stores.7

8. Independent and system-aligned physicians will retool.

If I were an independent or hospital-aligned primary-care physician, I’d be watching this eighth prediction with great interest. A top priority would be ensuring the practice had all the tools needed to stay competitive in a dramatically improved customer-centered ecosystem. The velocity of change is increasing. We should all hope this means both lower overall costs to the delivery of care and better health for everyone. But whether it does or not, nothing will stay the same.

WE WON’T BE BORED

In general, we can look forward to exciting times in health care. Nothing will replace the extraordinary skills and services provided by the ophthalmology community. Tracking the zigs and zags of the patient funnel, however, will require a whole new set of rules and tools. OM

REFERENCES

  1. Desilver D. For most workers, real wages have barely budged for decades. Pew Research Center. http://www.pewresearch.org/fact-tank/2014/10/09/for-most-workers-real-wages-have-barely-budged-for-decades/ . Accessed Jan. 10, 2018.
  2. Coombs B. United Health to buy DaVita Clinics for $4.9 billion. https://finance.yahoo.com/news/unitedhealth-buy-davita-clinics-4-114526999.html . Accessed Jan. 3, 2018.
  3. O’Donnell C, Berkrot B, Humer C. CVS eyes major expansion of health clinics with Aetna deal — sources. https://www.reuters.com/article/us-aetna-m-a-cvs-urgentcare/exclusive-cvs-eyes-major-expansion-of-health-clinics-with-aetna-deal-sources-idUSKBN1DV5TJ . Accessed Jan. 3, 2018
  4. Morgan J. Building telehealth into the master plan. Health Facilities Management. Aug. 16, 2017. https://www.hfmmagazine.com/articles/2053-building-telehealth-into-the-master-plan
  5. New physician workforce projections show the doctor shortage remains significant. AAMC. March 3, 2015. https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_projections_04052016.html
  6. Yahoo finance. Dec. 4, 2017. https://finance.yahoo.com/video/cvs-buy-aetna-69-billion-152700416.html
  7. Pickering S. A closer look at your Walmart Vision Center. Walmart Today. Sept. 25, 2015. https://blog.walmart.com/business/20150925/a-closer-look-at-your-walmart-vision-center . Accessed Jan. 10, 2018.

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