Healthhubs: cvs-aetna’s expansion into primary-care a major disruptor

HealthHUBs: CVS-Aetna’s Expansion Into Primary-Care a Major Disruptor  

Shortly after CVS Health merged with Aetna in November 2018, CVS Health announced the debut of its “HealthHUB” concept stores in Houston. These stores, which feature up to 80 percent of the primary-care scope (barring physicians) plus expanded staff and durable medical equipment, position CVS to become a lead disruptor in healthcare nationwide.

On June 4, 2019, the drug store giant announced it would expand these larger-format stores to 1,500 CVS stores nationwide. Atlanta, Philadelphia, and Tampa are next in line, foreshadowing not only increased competition between CVS and Walgreens, but also heightened opportunity for CVS to partner, or compete, with local providers on low acuity care, preventive care, and complex chronic care. Backed by the financial resources and national scope of CVS, and the data analytics and payer experience of Aetna, these HealthHUBs have the power to significantly disrupt traditional healthcare. Here’s how:

HealthHUBs will increase prescription drug sales, including for specialty drugs   

Aetna’s chronic disease spend of about $50 billion is incentivizing CVS to target patients with manageable conditions like diabetes and asthma/COPD. Driven by high-growth expectations in CVS’ specialty pharmacy business, CVS also has eyes on kidney disease, comorbidities, oncology, and rare diseases. Identifying low-hanging red flags and disease indicators inside these HealthHUBs, which offer about 80 percent of the primary scope in-store, could help CVS create captive pharmacy and medical device consumers (plus new participants in Aetna’s care management programs). The integration of pharmacist-led drug adherence coaching at HealthHUBs, multidose packaging services, and free drug delivery through a new program called CarePass, could further drive drug utilization and adherence. Non-Aetna plan members can also benefit from these services.

HealthHUBs will present opportunity for local providers to participate as a member of the care team 

CVS’ HealthHUB strategy includes in-store health concierges to guide patients to appropriate products and services, on-site dieticians and respiratory therapists, and off-site Aetna care coordinators who relay Minute Clinic patient information to patient’s primary-care physicians. Nurse practitioners refer the nearly 50 percent of Minute Clinic customers who do not have a primary-care physician to a PCP network comprised of local IDNs and practices. They may also encourage referrals to specialty physicians for individuals with high-acuity ailments. In some markets, pre-existing partnerships between Aetna and IDNs (like Memorial Hermann Health’s partnership with Aetna Whole Health in Houston) may help CVS determine in-network participants. Other value-based contracts between Aetna and providers are likely to develop as CVS builds out its innovative health model.

HealthHUBs will create mineable data repositories for CVS to address population health needs

CVS’ utilization of Aetna’s expansive claims data and HealthHUB patient health records will help CVS identify social determinants of health and market-level population health needs to drive appropriate medical and drug utilization. Correctly identifying gaps in care and providing affordable solutions will help position CVS as a prime partner for value-based contracting with pharma on high-cost drugs.

While HealthHUBs are poised to drive patient engagement, preventive medicine, and drug and product sales, success ultimately will depend on long-term consumer utilization.

Michelle La Vone Richardson is a Senior Analyst at DRG whose work appears in Health Plan Analysis and Market Overviews. Follow her @mlavoneDRG on Twitter for #retailclinic and #convenientcare updates.