As I wrote last week, the news that broke on October 26 that mega-pharmacy chain CVS was planning to acquire health insurer Aetna for a reported $66 billion, was a very big development in healthcare, with the potential for massive disruption of numerous sectors and subsectors in healthcare, from the pharmaceutical manufacturing world to the retail pharmacy world to the health insurer world to the hospital world to the physician world. It was one of those developments that really made a lot of people in healthcare, and beyond, sit up and ponder for a moment.
There was a fascinating potential “domino effect” involved. As a report on CNBC’s website explained it, “CVS talks to buy health insurer Aetna for as much as $66 billion makes sense because the drugstore operator and prescription benefit manager has been facing threats from all sides, including from Amazon, a leading analyst told CNBC on Friday. A deal of this nature would add health insurance plans to the CVS Health portfolio.” In that report, CNBC’s Berkeley Lovelace Jr. quoted Ana Gupte, a senior healthcare services analyst at Leerink Partners, as saying that "CVS has so many threats coming at them.” Gupte told Lovelace that one threat in particular is from OptumRx, UnitedHealth Group's pharmacy benefit management business.
So the threat to CVS from the pharmacy benefit management sector may now lead to one of the biggest retail pharmacy corporations acquiring one of the largest private health insurers in the U.S., which would then not only dramatically disrupt the health insurance sector, but would also have a huge ripple effect on the hospital sector, and especially on the physician sector. What will happen to the concept of physician practice? Will a combined CVS/Aetna mega-corporation (if the proposed merger is able to overcome any regulatory stumbling blocks) then move intensively into the business of hiring primary care physicians and advanced nurse practitioners, further upsetting an occupational market that’s already been whipsawed by massive crosscurrents coming from every policy, payment, business, and clinical source? The potentialities are mind-boggling.
Here's one thing that is very clear: the patient care organizations whose leaders are already innovating across a broad spectrum of areas of activity in terms of care delivery and operations, will most certainly fare better in this emerging environment than will the patient care organizations whose senior executives are focused exclusively or almost exclusively on holding onto the rapidly dwindling fee-for-service delivery and payment market. Indeed, the patient care organizations whose leaders are already pioneering change have a massive advantage right now in “skating to where the puck is headed,” as they say in the hockey world.
For nearly a decade now, we, the editors of Healthcare Informatics, have been proud and pleased to honor the leaders of pioneering patient care organizations, through our Healthcare Informatics Innovator Awards Program. Beginning in 2009, we reworked what had been an awards program focused on individuals, and instead, reframed it to focus on innovative teams—a natural focus, we believed and believe, for an industry in which nothing is created by lone individuals, but rather, in which innovation happens through the creative work of teams.
Just looking at the eight winning teams from the past two years gives one a sense of the breathtaking diversity of wonderful innovative efforts out there in the field. Earlier in the January/February issue of this year, we honored Minneapolis’s Allina Health, for its leveraging of process improvement techniques and information technology to dramatically improve cardiac care processes; Cincinnati’s Mercy Health, for integration of population health analytics into the organization’s clinical workflow, as part of an overall effort to achieve meaningful population health management, at the medical clinic level; St. Louis’s Mercy Health System, for its development of evidence-based clinical pathways, to systemically improve the delivery of high-cost procedures such as total joint replacements; and Boston’s East Boston Neighborhood Health Center, for its pioneering work in integrating behavioral and physical medical care, in a federally qualified health center setting.
Meanwhile, in 2016, we also honored four teams of innovators. At UT Southwestern Medical Center, leaders turbocharged quality improvement through its unique Ambulatory Quality Outcomes Project, whose work rapidly advanced innovation across 40 medical specialties; meanwhile, as a result of a data-driven, multidisciplinary initiative, the clinically integrated network Scottsdale Health Partners has streamlined its care coordination program using health IT solutions, so that care coordinators monitor patients in real-time and see more patients per day, ensuring proper transition care. Meanwhile, with the launch of PennOmics, a research data warehouse serving the hospitals of the University of Pennsylvania Health System and the Perelman School of Medicine, has given physicians and academic researchers there, access in one platform to massive amounts of de-identified, aggregate patient data from electronic health records and cancer genomics data from six formerly stand-alone system. And in Indiana, the Indiana Health Information Exchange is building a model that has potential to blaze the trail for other HIEs across the U.S. through its development of clinical messaging application in which more than 25,000 providers in over 6,000 locations throughout Indiana are receiving clinical results. And these descriptions cover just the eight winning teams from the past two years; we covered nearly 30 other winning teams in the seven years prior to these sets of winners.
What do the leaders of all of these pioneering organizations have in common, with their very diverse initiatives? A few things. First, in every case, individual leaders within these organizations have taken personal professional risk and have insisted on leading their colleagues forward into new ventures and new worlds. Second, all of these teams have built their initiatives in the context of cultures of innovation. And third, all of these teams have chosen areas of activity that involved significant change—all have taken on real challenges with real opportunities for improved clinical, financial, operational and patient/community satisfaction.
And that means that, at the very least, the leaders of these organizations are looking to healthcare’s future, not its past. And that means that there is far less likelihood that the organizations whose teams have achieved recognition through our program, will be caught flatfooted by the dramatic disruptions rocking the U.S. healthcare industry these days.
So as the story of the potential CVS/Aetna merger evolves forward, it’s important to keep in mind that we can only expect more and more—and more—change in the coming months and years. There’s no “insurance” against change in the world; but at least those skating to where the puck is headed, have better chances of surviving and thriving going forward.
So… how about you? Is your organization moving forward into healthcare’s future? Do you have teams doing important work in innovation? We’d love to know! Please consider sending us a submission in our 2018 Innovator Awards Program. Just click on this link and then click on the “Apply as a Provider” button. We also have an awards program for vendors, in which vendors can submit to be recognized for innovations around data security, value-based care, revenue cycle management, data analytics, and patient engagement. To submit in that division, just click here.
We at Healthcare Informatics are delighted to be able to recognize innovation, in both the provider and vendor divisions of our Innovator Awards Program. And we truly believe that, in a world of swirling, sometimes even mind-numbing, change, a continuous focus on innovation is one way to make sure one’s organization doesn’t end up getting stuck in the past.