In early December, CVS Health announced it had agreed to acquire Aetna in a $69 billion deal that would merge the drugstore giant with one of the biggest health insurers in the U.S, a move that could alter the competitive landscape for physician practices.
CVS operates a chain of pharmacies and retail clinics that Aetna could now use to provide care directly to patients, potentially offering employers one-stop shopping for health services for their workers. The deal still needs to be approved by government regulators.
Jamie Thomas, executive vice president of The Medicus Firm, a Dallas, Texas-based physician recruiting firm, believes the proposed deal could prompt further consolidation in the primary care arena and will create further competition for primary care physician (PCP) practices.
“More traditional medical practices could be forced to increase hours and/or work weekends to compete with the convenience the walk-in clinics offer,” he says.
That could result in a lack of continuity in primary care, and the eventual erosion of the PCP/patient relationship, which he says has proven to positively affect outcomes.
Matthew Mintz, MD, FACP, an internist in Bethesda, Maryland, worries that CVS may incentivize Aetna patients not only to use Caremark/CVS PBM, but also CVS retail pharmacies.
“This may give few options of where patients can get their medications and by expanding the footprint of the CVS/Caremark formulary, leave providers with fewer choices of medications to treat their patients with,” Mintz tells Medical Economics in an email. “CVS may also incentivize Aetna patients to get their immunizations from a CVS retail store. While that may help patients a little, and immunizations are not a huge money maker for many PCPs, that’s a lost revenue opportunity for PCPs.”
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Another concern is that public statements about the proposed merger by executives indicate that the company plans to expand healthcare delivery in CVS Minute Clinics. Mintz says that while this could in theory increase after-hours access and decrease emergency department visits, Minute Clinics thus far have not shown to be able to deliver a high level of care.
“You will hear countless stories from PCPs regarding how a patient was misdiagnosed in a Minute Clinic, and then had to see the PCP anyway to deal with the consequences,” he says. “In my experience as a provider, going to a Minute Clinic often results in a prescription. I think there is a potential conflict of interest when the employer of a health practitioner is a pharmacy that profits off prescriptions.”