How the CVS-Aetna merger could lower healthcare costs

Healthcare in the United States is a mess and confuses even savvy professionals. With this complexity and significant increases in cost sharing, it’s no wonder many Americans have no primary care doctor and almost half are dissatisfied with the cost of care they get.

Chronic care costs about 80%–90% of the country's annual healthcare expenditures, and some estimate that as much as 25% of those costs are duplicative, wasteful or avoidable.

So what can CVS-Aetna do about this?

The retailer has a lot of clinical resources. Opening up the MinuteClinic model will provide an easy-to-access, front door portal to cost-effective care for acute and chronic conditions — which can help simplify care. I especially like the pharmacist’s role in this model since prescriptions are the most frequent access point to care. Integrating the pharmacist into care triage to aid in steerage to a primary care provider is a low-hanging fruit solution — and allowing that pharmacist to provide needed advice and follow-up on chronic-care treatment can only serve to lower those costs.

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CVS Health Corp. signage is displayed outside a store in downtown Los Angeles, California, U.S., on Friday, Oct. 27, 2017. Photographer: Christopher Lee/Bloomberg

CVS-Aetna will have better data available to arm these clinicians with timely care considerations, helping Aetna members take what CVS-Aetna calls the “next best action” in healthcare. And it’s easy to see that this can be supported by seamless electronic medical records.

Also see: What benefits insiders are saying about the CVS-Aetna deal

The MinuteClinic can also provide a lower-cost care setting for things like infusion therapy. This is a hot topic in cost savings — moving from the highest-cost inpatient setting, the clinic setting seems like a logical stopping point for many who are uncomfortable with performing self-infusion at home. Also, integrating the availability of often-fragile specialty medication, which may need refrigeration or other special handling, will no doubt create efficiencies and lower costs.

These clinics can also save money on the estimated 30% steerable emergency room visits. And post-surgical care coordination might be efficiently and effectively delivered by a local pharmacy supported by their clinical team.

No doubt healthcare is about to embark on the type of change, facilitated by access and digital tools, which has swept much of our economy. I expect that we are just a few years away from lower costs and greater efficiency in healthcare delivery. This transaction will prove to be a big catalyst for change.

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