Mintz adds that if Aetna is providing care at a CVS retail pharmacy at a lower cost than a community PCP, the merged company could incentivize patients to get primary care at the CVS. For example, co-pays for sore throat and chronic care (asthma, diabetes, HTN) done by a nurse practitioner at the Minute Clinic might be free for Aetna patients, but $20 when performed by an in-network provider. This could take revenue away from PCPs if incentives like these are put in place.
“This is a big deal,” Mintz says. “Except for Kaiser (for the most part), insurance companies are not generally the providers of healthcare. While in theory, a group of NPs could set up their own private practice minute clinic and then contract at even lower rates, this just doesn’t happen. CVS Minute Clinic is a very low cost provision of a limited number of healthcare services. Rather than go see their doctor for common things, it would cost Aetna less if their patients went to a Minute Clinic first.”
Not only would Aetna have a lower cost of care for their covered patients, but they will profit from that care, and if the NP prescribes antibiotics or even OTC medications, they profit even further.
Is there a bright side?
Paula Muto, MD, FACS, a vascular and general surgeon in Lawrence, Massachusetts, says the primary care world has splintered, with burdensome regulation having usurped the doctor’s time with patients.
“If walk-ins take away some of the burden of over-crowded waiting rooms, then there will be more time for patients who need them,” she says. “However, primaries in networks will be frustrated if patients don’t follow the prescribed insurance rules. Because the reimbursements are tied to patient compliance, they will be penalized. This will lead to more stringent requirements and either a mass exodus of participating doctors or the expansion of alternatives like concierge practices, telemedicine and direct primary care.”
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Ryan Marling, healthcare research associate with the Clayton Christensen Institute, says that rather than competing with CVS Health clinics, this merger is an opportunity for PCPs to coordinate with the retail health space, which CVS has done with major health systems such as the Cleveland Clinic.
“As leaders of these caregiving teams … PCPs will play an important role in coordinating and tailoring team structures and processes to the health needs of individual patients,” he says. “If implemented effectively, team-based care arrangements will ultimately help PCPs practice at the top of their license, enabling them to focus on strengthening patient relationships and constructing cost-effective care regimens for those with multiple chronic conditions.”