CVS Health Using Home Health, Hospice Providers to Deliver Care Further Upstream

CVS Health (NYSE: CVS) recently floated the idea of home health acquisitions and partnerships. Mostly, it has repeatedly doubled down on the idea that it wants to get into the home.

Of the driving forces of that is its own insurer, Aetna. What Aetna believes is best for its members and the health of its business naturally makes its way up to the top of the CVS ladder.

One of the reasons some believe CVS Health is the best suited retailer to take on the home is its ownership of Aetna.

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Aman Gill, the director of product strategy and innovation at Aetna, is in the middle of that strategy alignment. Having worked her way up in the company, she’s seen how things have changed in health care over the last few years.

To get a closer look at each company and what their plans are in the home, Home Health Care News sat down with Gill recently in Chicago.

The conversation is below, edited for length and clarity.

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HHCN: Some insiders believe CVS has an inherent advantage because of Aetna. Now, there are other payers getting into home health, like you guys are. How does that change things, if at all, that so many payers like yourself are getting involved in home health, hospice and palliative care?

Gill: I think for us, it’s a huge advantage, right? CVS Health has Aetna, and at Aetna, we have built a lot of our care management programs around benefiting our members.

Our mission drives us to take care of our members. Our mission really is to think about the member as a whole. So I think as some of the other competitors are now trying to play in the same space, they’re kind of trying to catch on to a lot of that, right? 

Where for us, we’ve been in it, so we’re already a pioneer. We have Aetna Compassionate Care, which is a program that’s been live for a couple of years, and is currently managed by some of the brightest clinical leadership that we have. 

Now, some of these other providers are trying to acquire to get to the point where [we think we’re at]. And I’m not saying it’s late to the game – I think it’s great, because the person that’s going to benefit from this is going to be the members.

CVS has obviously already done work in the home. But there have been some hints dropped about getting more into home health through acquisition, is that something you’re thinking about? 

I think it’s always on the table, I’m not going to tell you it’s off the table.

Where I sit is under that innovation umbrella. One of the other things I’m constantly looking at – and my leadership is, too – is, ‘What are different ways to deliver that care to the member where they want to be?’ One of our mottos is, ‘Let’s meet our members where they are.’ If they want to be in the home, let’s figure out how to make that happen.

So it is on the table. And we are figuring it out, but it’s like any other new idea. It’s very complex. It’s figuring things out like — at what point is it okay to be at home for that care? Or, at what point does that member need institutional help? And we have to help the member understand that.

In terms of home health and hospice providers, do you consider them competitors?

Absolutely not.

When we were designing [our hospice program, for instance], we hand-picked some of these providers to work with.

And it really was soliciting their help on how to best care for these members, because they are on the front lines. So we asked what is going to be beneficial, where the gaps were, what they see in home health and hospice members, what may we not understand from a plan perspective.

These are partnerships, and we wouldn’t be able to do it right without them.

Medicare Advantage and home health care providers have tense relationships at times. But it’s obvious they are going to be working more with each other in the future. What are your thoughts on that?

There’s definitely some of that. But at the same time, I think we have to come up with an understanding on how home health fits into each members’ journey. And MA, the U.S. Centers for Medicare & Medicaid – whoever – they have to be able to kind of see that variation of pictures dependent on the number of comorbidities.

So it may fit in for one, and it may not fit in for another.

We have to think about the member as the person that we’re designing these plans around, instead of designing and then hoping the members will fall into a certain bucket.

What are you seeing with home-based supplemental benefits? How much do you guys believe in those kinds of benefits? And is that something you’re looking to implement more going forward?

It’s need based. Home-based care isn’t going to be right for everyone.

And if the member wants it, it still has to make sense from a clinical perspective. At the same time, you’re going to respect member choice.

We are evaluating it. Whenever we get a flexibility from Medicare Advantage, we are looking through those things. Do I have a definite answer I’m going to tell you based on which ones we’re going into? No. Because, again, it is need based, it’s really thought through based on the program. 

So, we’ll think about it based on the different populations and what needs they do have.

What are you most excited about at Aetna over the next three to five years?

I think we have a great opportunity. And we have great leadership that wants to explore all of these different models.

We’ve really taken a thoughtful approach, because I don’t want to grow and then provide solutions that are blanket ones.

We’ve been very strategic and careful about where we’re launching these programs. So Pennsylvania is one of my states, as well as Ohio, where we have a hospice programs today. And we’ve really, really thought through partners that we would want to work with. We went through a full book of business and narrowed it down.

At the same time, you look at the population – you look at the claims data and see what’s coming in – and think about what are some of the other supplemental benefits that we can put in, for example.

We’ve really thought through that member journey on how we design things. And where we’re looking to go is even more upstream. It’s not just hospice, we’ve baked in that palliative care portion too.

But we’re really thinking about which providers we want to be with. Because we want those providers to share the same values and mission, and also to have that thought process on how we want to address that. So I think we’ll continue to do that.

I don’t want that black box where we say, ‘Here are the requirements.’ And, ‘Here’s what I want you to push to the members.’ We’re very thoughtful. We have regular touch points with our provider partners. We want to know where things don’t align and where the discrepancies are. So over the next three to five years, we’re really continuing to focus on the partners that we want to be on this journey together with.

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