Happy Holidays !!!!!!!! (Let’s Change Things…)

Health Data Buzz has been thinking, working, resting, rejuvenating — but most of all wishing you the very best of holiday seasons, and looking toward a great 2018.  Thank you terrific readers!

Great, I know, I know. It sounds like some people talking that aren’t so great.

Let’s work together and do the best we can — and then some.

There haven’t been many stories lately in Health Data Buzz — but, oh, we are working on them — more in-depth, giving readers more of a reason to —- read them.

We can change things for the better. Beyond this blog. Beyond ourselves. Let’s be healthy together.

If you don’t like something, change it. If you can’t change it, change your attitude.”Maya Angelou.

And with that attitude readjustment, change inevitably comes on the inside – and outside. — Joe Cantlupe

 

The CVS-Aetna Merger: Now Comes The Fine Print for Consumers. Is It A Match?

Amid the hoopla echoed by CVS and Aetna over their proposed merger, cost savings for consumers are what the duo talks about very much. But some worry that other mergers didn’t work out that way, history has this nasty habit of repeating itself, and the greatest benefit may be to the corporation rather than the average buyer of drugs and other pharmaceutical products and wellness services.

The proposed $69 billion merger “set off a wave of speculation “and “few expect drug costs, which have been rising, to decline under this arrangement,” said The New York Times.

At the outset, what does CVS, the large pharmacy, gain from the merger with the giant insurer? With the deal, CVS “would gain instant access to Aetna’s 23.1 million medical members and 15.2 million PBM (pharmacy benefit manager) customers,” the Employee Benefit Advisor said.

It noted that CVS already has tied the knot in different ways with Aetna. “CVS inked a 12-year contract with Aetna in 2010 to service about 9.7 million of the insurer’s PBM  members,” the EBA said. If the deal is approved by regulators, “what can brokers, advisors and their employer customers expect to see happen with drug prices?” EBA asked.

Answering that question is, well, pretty uncertain.

The Employee Benefit Advisor said that one of the CVS divisions has improved “patient engagement and medication adherence” through “personalized medicine” that many in healthcare are aiming for – but the EBA notes “some brokers worry that a CVS-Aetna pairing could corner the market on certain high-cost drugs.”

IMG_1493One of the top voices of concern is National Community Pharmacists Association CEO B. Douglas Hoey, who said in a statement he fears the proposed merger would not only generate cost savings for the corporation, but “there may be detrimental effects on consumers and community pharmacy providers.” The National Community Pharmacists Association represents the interests of America’s community pharmacists, including the owners of more than 22,000 independent community pharmacies.

“For all of the talk about cost savings, prescription drug costs have clearly continued to rise despite previous vertical mergers like UnitedHealth’s 2015 acquisition of Catamaran,” a pharmacy benefits manager, he said. “Moreover, the anticipated efficiencies CVS and Aetna tout may benefit the merged company more than the consumer, who is likelier to be driven to use health care resources chosen by the health plan rather than those of his or her own choosing.”

As regulators evaluate the plans for the potential impacts, the companies’ “previous and current behavior” should be considered, Hoey said. He emphasized two points:

  • “In 2015, Aetna was assessed a $1 million civil monetary penalty by the Centers for Medicare & Medicaid Services for significant disruption to patients and community pharmacists that occurred as a result of the company’s inaccurate representation of ‘in-network’ pharmacies in some plans.”
  • “CVS/Caremark is already the pharmacy benefits manager for Aetna, and independent pharmacies have been foreclosed from Aetna’s Part D preferred networks for the last two years. Consolidation of the two companies will only strengthen their ability to steer patients to CVS/Aetna-owned retail or mail order pharmacies.”

“Consumers should have the freedom to choose the providers that produce the highest quality health outcomes and cost-effectiveness, rather than being coerced into using certain physicians or pharmacies,”  Hoey said. “In short, bigger is not always better. A close examination of whether this acquisition will lead to higher drug prices and fewer quality and convenience options for consumers is warranted.”  – Joe Cantlupe

 

Another Reason To Stop At CVS?….Or Is Merger Medicine A Tough Pill to Swallow?

As CVS and Aetna see it, the multi-billion dollar companies are getting together to tap into data and the “human touch” to transform and “redefine access” to health care.

How? By reducing costs,  help fight chronic conditions and lower readmission rates through an “effective integrated community-based health care delivery system,” the companies predict.

Today, CVS, the giant pharmacy,  announced it is buying Aetna, the giant insurer, for $69 billion — $77 billion including debt – that could have a significant impact on healthcare. The plan, if approved, would result in a company with an annual revenue of $240 billion – second only to Walmart in the U.S, according to news reports.

Ironically, as Congress seems confused about health care, the private sector is moving forward, with these major players aligning its futures into a growing force: personalized medicine. But the overall impact of the deal remains to be seen, and whether the proposed merger will even fly —  with regulators surely ready to raise questions about this huge health insurance deal

And there’s another question. Is this good for consumers?  The Coalition To Protect Patient Choice, said of the $200 per share offer: “This massive merger would greatly harm consumers, leading to less consumer choice and more exclusionary conduct, and (the) promised savings will not materialize.”

The move is considered by the companies as a “natural evolution as they seek to put the consumer at the of heath care delivery.” They said: “CVS Health has steadily become an integrated health care company, and Aetna has moved beyond being a traditional insurer to focus more on consumer well-being.”

CVS said the “transaction fills an unmet need in the current health system and presents a unique opportunity to redefine access to high-quality care in lower cost, local settings whether in the community, at home, or through digital tools.”

There are more than 9,700 CVS pharmacy locations and 1,100 walk-in clinics and other programs including 4,000 CVS Health nurses who provide  in-clinic and home-based care, the company says. By connecting with Aetna, which serves more than 44 million people and its  network of providers, CVS believes  “there will be a better opportunity to utilize local care solutions in a more integrated fashion with the goal of improving patient outcomes.”

“This combination brings together the expertise of two great companies to remake the consumer health care experience,” said CVS Health President and CEO Larry J. Merlo. “With the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals.”

Said Mark T. Bertolini, the Aetna chairman and CEO: “Together with CVS Health, we will better understand our members’ health goals, guide them through the health care system and help them achieve their best health.”

As a “benefit to consumers,” CVS says its pharmacies will include “space for wellness, clinical and pharmacy services, vision, hearing, nutrition, beauty and medical equipment, in addition to the products and services our customers currently enjoy.”

“An entirely new health services offering available in many locations will function as a community-based health hub dedicated to connecting the pathways needed to improve health and prescription drugs and health coverage.”

No doubt, a hub of controversy, too.

— Joe Cantlupe