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It's the end of the world (of health) as we know it



This week, it was announced that two of the biggest players in the health market have agreed to merge into a deal worth almost $ 70 billion. This merger represents a deviation from the traditional way that doctors, patients, insurers and pharmacists have interacted for decades. In the past, insurers and pharmacies have existed in separate silos.

As I mentioned in a recent piece, this old system was far from perfect. Pharmaceutical benefits managers (PBMs) have taken advantage of patients, doctors and drug manufacturers and increased the cost of drugs through demanding bribes known as "reimbursements." As bad as the PBMs have been for health care, this new fusion may worsen.

Now, mergers such as the CVS / Aetna agreement will essentially bring the "Soprano-like" PBMs into the company. In addition, in recent years, CVS has ventured into the market of health care providers as well as primary care "clinics" of personnel with pharmacists and nurse practitioners in retail stores (note the apparent absence of physicians in the healthcare model). of CVS). While CVS argues that the combination of a health insurance company and a pharmacy (which provides primary care services) will simplify patient care and reduce costs, I think it is likely to do the exact opposite.

If this merger is allowed to continue, all players (except the mega conglomerate CVS / Aetna) in the health system will suffer.

Decrease in choice

Currently, many patients have limited access to medications due to the role in which PBMs play in negotiating prices and determining what is in the "form". This non-transparent process basically involves a system of offers from manufacturers where the highest bidder (for a refund that pockets the PBM) wins the status of the preferred form. [1

9659002] In addition, PBMs may require patients to undergo a "step therapy" process where they are forced to use less expensive (and potentially less effective) medications than originally prescribed by their physician before being administered. He is allowed to take the desired therapy.

If this acquisition is allowed to continue, we will see even fewer options. Now, an insurer (who is financially motivated to prohibit access to more expensive therapies) will be associated with a pharmacy that may choose to buy only certain medications. Pricing can become the norm: if you are an Aetna customer, you may only be able to buy your CVS medications, even if there are cheaper options for you elsewhere.

Increase in costs

When there is less competition, the consumer always suffers. If we allow CVS and Aetna to merge, we are likely to see an increase in costs. Consumers of health services will not be able to buy less expensive purchase options. I foresee a system in which Aetna can dictate that all covered medications must be purchased in CVS.

The death of the Doctor-patient relationship

Medicine is defined by the way in which physicians and patients interact. Trust is built through years of interactions, not in a tiny clinic. By removing the doctor from the health care equation (as this merger will), patients will no longer be able to link with a provider who can help them make difficult medical decisions as they get older. The clinic's painstaking staff tends to be more transient than doctors who work in long-term medical offices and groups.

Although tiny clinics can be a great way to classify and treat simple, common primary care problems like colds and flu, it is not a great place for long-term care for chronic diseases. Highly trained doctors who have completed three to 10 years of residency and fellowship training after completing their medical degrees are better equipped to make difficult diagnoses and handle complex diseases over time. As a for-profit entity, CVS focuses on cost containment, and nursing professionals are much cheaper than board-certified physicians. In an ideal world, PNs and doctors work together and co-minister with patients, as each professional brings a unique perspective and a unique set of skills to the clinical setting.

Lower results

When we focus purely on the economics of medical care instead of evidence-based medicine for the choice of therapy, the results will certainly be less favorable. If the CVS / Aetna merger is allowed to continue, I hope that all the clinical decisions of the CVS minutes clinic staff are based on the protocols and treatment algorithms that are developed to contain the costs. Let's face it: CVS and Aetna are dedicated to this to make money for their executives and their shareholders: the patient really is not their top priority. The care provided only by a nurse practitioner in a one-minute clinic is not the same as the care provided by a resident and / or a trained physician in a continuity clinic.

Ultimately, I hope federal regulators recognize this planned acquisition for what it is: an assault on the way medicine is practiced. We continue to allow for-profit corporations to dominate decision-making when it comes to health policy.

We must act to change this paradigm and put patients first.

As Michael Stipe of R.E.M. he wrote in a song, "the world satisfies its own needs, does not forget its own needs". If we do not act, this fusion will be the first of many and will probably be "The end of the world (sanitary) as We know it".

Kevin Campbell ( @DrKevinCampbell ) is a contributor to the Washington Examiner & # 39; s Beltway Confidential blog. He is an internationally recognized cardiologist and medicine, health and wellness expert. He is the author of two books and appears regularly on Fox News, Fox Business, CBS and other media. Dr. Campbell is the CEO of PaceMate, a health data solutions company.

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