CVS-Aetna deal could be costly for independent physician practices

Nearly a year ago, physicians’ groups were celebrating a federal judge’s decision to block a $37 billion merger between insurers Aetna and Humana, calling it a win for patients and physicians.

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Now, those same groups are trying to figure out the implications of Aetna’s sale to CVS Health in another multi-billion-dollar blockbuster billed as a game-changer for U.S. healthcare.

The pharmacy chain’s announcement that it was purchasing Aetna for $69 billion was described as a boon for consumers by both companies. Aetna’s more than 23 million medical members-many of whom likely see private practice physicians for care-will now have “greater consumer access” via 9,700 CVS Pharmacy locations and 1,100 MinuteClinic walk-in facilities, according to a press release. 

For CVS, this means millions of patients can pick up prescriptions and many other health and wellness products in their stores. For Aetna, it’s clearly cheaper to pay for care at a MinuteClinic staffed by non-physician providers than at physician practices.

And there is this lingering question: Will CVS require patients to go to MinuteClinics instead of the physician they are used to seeing? The press release announcing the acquisition says CVS Health plans to “connect” the payer’s provider network with “local care solutions” (i.e. retail stores) to improve patient outcomes.

But if CVS starts diverting patients from primary care physicians to “local care solutions” for services like flu shots, diabetes education and other activities now taking place in physicians’ offices-even on a voluntary basis-doctors will lose reimbursement opportunities for those services.

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Patients already see the benefits of retail-based care, from the ability to shop while they wait to every location knowing their name, insurance and other pertinent medical information-something electronic health records have failed to provide for various primary care physician locations via interoperability. So why wouldn’t patients visit one of many CVS locations in their community to get care, rather than one primary care office? 

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Once again, smaller physician practices will be up against a well-funded giant competing for their patients. But this time it isn’t a hospital. It’s a billion-dollar pharmacy chain who can not only encourage patients to come in for deals on everything from vitamins to stationary during their visit, but could possibly force Aetna plan members into their stores for some types of care.

It’s never too early for physicians to remind patients that “convenient” care isn’t always the best care. 

Keith L. Martin is editorial director of Medical Economics. Do you think the CVS-Aetna deal is good for physicians? Let your voice be heard. Contact us at medec@ubm.com.