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Column: CVS-Aetna deal is about catching up to UnitedHealth

Lee Schafer, Star Tribune (Minneapolis) on

Published in Health & Fitness

For years it was understood that maybe half of American adults lived with at least one chronic condition, defined as the kind of health problem that needs to be treated or limits a person's ability for a year or more, but the most recent study from RAND Corp. concluded it was more like six in 10 American adults.

The stereotype people might have is of seniors lugging around a tote bag of pill bottles, but the RAND study found that about half of Americans in their mid-40s to mid-60s live with multiple health conditions, too.

RAND highlighted an active and working 44-year-old being treated for fibromyalgia, asthma, anxiety and other conditions that required nine prescriptions per day, some presumably for the rest of her life. Its point in describing this case was that she was not particularly unusual.

People with chronic conditions can be expensive to take care of. The 12 percent of Americans who live with five or more of them account for 41 cents out of every dollar spent on health care.

A big part of that, of course, is what they (and their insurer) spend on their medications, but they also go to the doctor a lot. This is very old news to the people who run health insurance companies like UnitedHealth.

The approach to keep them healthier and bring down costs that seems to work best is an integrated approach to helping people better manage their health. And UnitedHealth is simply ahead of CVS at delivering that and still will be after this deal closes.

UnitedHealth's OptumRx unit oversees the pharmacy benefits of more than 65 million people, processing more than 1.25 billion prescriptions every year. At last count it had about 22 percent of the market, just a bit behind CVS. OptumRx has been notably good at lowering the costs of expensive specialty drugs for Medicare members, according to Credit Suisse.

As just one example of a recent initiative to control drug costs, UnitedHealth has introduced a quick way for doctors and other clinicians to do a quick trial claim before writing a prescription for a patient. Some medications require an insurance authorization before being prescribed, so with a few clicks the doctor can ask for that.

The tool will also point to cheaper, comparable medications that would cost the patient -- and the health care system -- a lot less.

 

Another idea behind CVS' plan for the Aetna deal is having the health care insurer get far more active in helping patients manage their own health, rather than get sick enough to decide to visit their doctor and then have the health insurer pay for more complex and expensive care.

Communicating with members when they visit a store, maybe just minutes away from home, can be a great way to help share with them what CVS and Aetna know about effectively managing their heart disease or diabetes.

CVS Chief Executive Larry Merlo tried to explain a little of that thinking to investors in a Monday conference call about the merger, although he did not disclose a plan to take that idea a big step further by making house calls, only a "perhaps" in response to a question.

At UnitedHealth, the idea of using house calls has long since been implemented, of course. By the end of the month, it hopes to have made 1.2 million home visits just this year.

(c)2017 Star Tribune (Minneapolis)

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