Proposed CVS-Aetna Deal Should Scare Primary-Care Practices

December 8, 2017

The CVS-Aetna $69 billion merger is going to cause a lot of headaches for primary-care physician practices.

Welcome to Editor's Corner. Here, the editors of Physicians Practice will share their thoughts on the happenings in healthcare and look at the industry from a broader viewpoint.

A few months before my son was born, I went to CVS and got a tetanus shot.

My primary-care physician had left his medical group and I needed to get the shot before the baby arrived. Not wanting to go through the process of finding a primary-care physician for  a single shot, I decided CVS would suffice. And it did. I got the shot and didn't have to worry about getting vaccinated the day my son came into my life (something I had to do for my niece).

CVS isn't your doctor, nor do they pretend to be your doctor. In fact, the physician assistant who performed the shot on me asked if I wanted to keep records of the shot for my (non-existent) doctor. I said I didn't have one, but I'd keep it anyway, once I did find a new one.

In due time though, patients may never actually need a primary-care doctor. At least, that's what CVS and Aetna are trying to do and if you’re a physician in a practice, it should scare you.  

In case you aren't following the news (and for that I can't entirely blame you), this past week CVS announced it was purchasing health insurer Aetna for a whopping $69 billion. This is a major business transaction in healthcare and many sides will feel the impact.

The deal will certainly fall under heavy regulatory scrutiny. Just like Aetna's last attempt with Humana, it is far from a sure thing. Even under a more business friendly administration, $69 billion mergers don't just get to happen without some kind of antitrust examination. But if it does happen, it's a chilling combination for physician practices and hospitals alike - especially ones in the business of primary care.

Here are the words of Aetna CEO Mark Bertolini at the announcement (I apologize, it's a lot, but I think it's important):

The real important part here is that we need to understand that almost 60 percent of Americans don't have a regular doctor. A lot of people can't get in to see the doctor they want to see. So I view the offering - I think it's less about what the store looks like and more about the offering, and the experience the customer gets is really about a patient-centered medical home model, where we're supporting interaction with the medical community, preparing people for appropriate compliance, preparing them for their visits, setting up appointments, eliminating prior ops, doing all those other sorts of things to help navigate that system for them.

Patient-centered care is obviously on the rise, but what Bertolini is describing sounds awfully like what the primary-care physician and his staff are supposed to do, doesn't it? It makes sense to go after the insurance companies' costliest patients - those with chronic disease - and create a hub where they navigate the healthcare system, access specific medications, and receive the basic services offered by any primary-care doctor (as well as CVS MinuteClinics). It's in Aetna's interest to bring information on those patients to CVS and it's in CVS' interest to be those patients' guiding light. Those patients need a lot of lights and that's a lot of revenue streams for CVS.

But that puts them in the direct line of primary-care physicians, who in the patient-centered medical home model are supposed to be the essential key ingredient. If you think of healthcare as a wheel, each specialist that deals with a patient are the spokes and at the center of that wheel is the hub, the primary-care physician. CVS/Aetna wants to be that hub. They even said it during the announcement!

Where does that leave primary-care physicians? Well Bertolini's comments make it seem like they're not necessary and maybe for people of a certain age, that's true. As I've written before, primary-care practices don't have the same convenience factor as doc-in-a-box clinics. For people of my generation, convenience is of the upmost importance.  I think that's where that 60 percent number comes from.

Here's the thing though. This CVS/Aetna marriage seems to take aim at patients who have multiple diseases and need to navigate the complex healthcare system. I've got news for CVS/Aetna. I would guarantee most of patients do have a primary-care physician and they need those physicians. The quality that a primary-care physician and his staff can provide is absolutely necessary to ensuring those patients get the best, most effective care possible.

A CVS/Aetna marriage could stand in the way of that and yes, that's a little scary.