The proposed consolidation of Aetna and CVS can be viewed as a natural step in the evolution of both companies. CVS began as a pharmacy chain, acquired pharmacy benefit management (PBM) capacity, and added numerous Minute Clinics to provide easy access and low-cost usual care, then discontinued the sale of tobacco products as it changed its name to CVS Health.
At the same time Aetna, along with other large national insurers, has been converting from largely wholesale operations focused on the employer to more retail operations infused with an emphasis on consumerism. This is reflected not only in the emergence of consumer-directed health insurance benefits, which are designed to give consumers more “skin in the game,” but also in an array of direct-to-consumer outreach efforts, many of which aid patients in navigating the health care system and managing their own health and wellness.
With these trends in mind it becomes clear why CVS and Aetna would want to partner. The resulting company would have unprecedented points of attachment to consumers on a national scale. CVS brings a national network of over 10,000 retail pharmacies including well over 1,000 Minute Clinics, and a large PBM, which manages pharmaceutical services for millions of customers. Aetna brings a brand name national insurance operation and a respected portfolio of health care management capacities, ranging from programs on precision medicine (such as genetic testing and counseling to guide patients’ responses to new genetic information) to end-of-life care and numerous case management and disease management programs. Perhaps most importantly, it delivers over 22 million Aetna members to the CVS franchise.
CVS CEO Larry Merlo states that the consolidation will bring “10,000 new front doors to the healthcare system” to the public. This can work for the consumer if it delivers on the promise of facilitating access to high-quality primary care in more ways than currently delivered in the rather bare bones CVS Minute Clinics. Expect to see audiology and vision services, among others. This will facilitate one-stop shopping and can lower costs, as walk-in clinics deliver care more efficiently.
In addition, the infusion of millions of Aetna members should result in CVS getting better prices from drug wholesalers, which can be reflected in lower premiums and out of pocket expenses. And the fact that CVS has over 10,000 retail sites will certainly be more convenient for patients, especially if they are saving money by traveling to them.
Some critics of the CVS-Aetna merger fear that it could lead to higher costs and reduced choices for consumers. Yet if the companies continue to follow their previous consumer-oriented trend, the deal could benefit shareholders and consumers alike.
John W. Rowe is the Julius B. Richmond professor of health policy and aging at the Mailman School of Public Health at Columbia University. He previously served as chairman and CEO of Aetna.
