Introducing Healthcare Hot Takes: How CVS Health & Aetna Will Impact Local Communities

Healthcare Hot Takes is Luma Health’s monthly rundown of healthcare innovations that are happening right now. Check out what the industry is thinking, reading, & doing. This month’s main topic is CVS Health buying Aetna.

Story #1: CVS Health Has Agreed to Buy Aetna for $69 Billion

This is a big deal – mainly because it has the potential to dramatically reduce healthcare costs by shifting care away from hospitals and health centers and into the community. The goal of this merger is to provide a better overall healthcare journey by increasing access to things like patient care, prescription drugs, and health benefits (all equally positive things in our book).

Let’s say a consumer is currently employed under an Aetna health insurance plan. With the new merger, that same consumer would be able to get care at a CVS walk-in clinic, be prescribed medication during their visit, and then pick up the prescription at that same CVS pharmacy immediately – a literal “one-stop shop.”  Patients will transition to see providers, nurses, pharmacists, counselors, etc. at local CVS “MinuteClinics” instead of at primary care clinics or outpatient centers that may be located further away.

For scale and context, CVS Health currently operates over 10,000 pharmacy and clinic locations throughout the U.S., while Aetna is one of the largest health insurers in the country.

“This combination brings together the expertise of two great companies to remake the consumer healthcare experience…”

Larry J. Merlo, CVS Health President & CEO

“…With the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals. We look forward to working with the talented people at Aetna to position the combined company as America’s front door to quality health care, integrating more closely the work of doctors, pharmacists, other healthcare professionals and health benefits companies to create a platform that is easier to use and less expensive for consumers.”

These community-based clinics would actually have the ability to provide quality care based on the extensive resources that both companies currently possess and have invested in. For example, CVS Health has established partnerships with a number of forward-thinking telehealth companies.  Likewise, Aetna has partnered with telemedicine giant, Teladoc, to offer services on top of what is laid out in current benefits plans.

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Many believe this deal is a direct result of Amazon’s rumored plans to enter the pharmacy space.  Therefore, CVS and Aetna have taken a defensive first step in planning for the future. (For reference, Walmart is said to have been eyeing Humana, and both Anthem and Cigna have targeted Walgreens.)

This merger is most assuredly only the first domino to fall in the rapidly changing US healthcare industry.  With this deal, consumers can expect to experience the direct impact of healthcare in their own communities.

The CVS-Aetna merger also symbolizes a larger trend in healthcare –the consolidation of systems in an effort to transition to a more value-based approach.

Check out some of these other healthcare mergers that just took place:

Story #2: AI In Healthcare

Artificial intelligence isn’t just today’s tech buzzword but is a vehicle that has shown a promising future in healthcare, with abilities as advanced as early detection and prevention of disease.  Technology titans like Google and IBM have invested countless resources in developing AI to address healthcare inefficiencies with projects Google Deepmind Health and IBM WatsonPaths, respectively.

Here are two lesser-known companies using AI in innovative and unique ways within the healthcare industry.  

1. Prognos – Prognos is a New York City-based startup using highly developed AI to evaluate clinical lab results to predict someone’s risk for a certain illness. The company just secured $20.5M in Series C funding.

By using their algorithms and a database of over 13 billion medical records, Prognos helps clinicians make data-driven decisions about a patient’s care plan.  The goal is to use AI for early insight about a patient’s health to deliver better care and lower costs – a win-win.

2. Careskore – Careskore uses a combination of clinical, demographic, and behavioral patient data to power its algorithm, which can predict how likely it is that a patient will be readmitted to the hospital.  They offer personalized communication so that patients can get a clearer picture of their health and take steps to improve their wellbeing.  They also empower hospitals to reduce readmission rates and improve the quality of their care.

Founded in 2014 and based in Chicago, Careskore has raised over $4M in seed funding.

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