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.