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CVS Health (NYSE: CVS) is one of the most influential health care entities in the United States. It having the health insurance giant Aetna underneath its umbrella is no small part of that.
As some of the larger retailers in the U.S. have gotten further into home-based care – including Walgreens Boots Alliance (Nasdaq: WBA), Walmart (NYSE: WMT), Amazon (Nasdaq: AMZN) and others – insiders have especially kept their eye on CVS because of Aetna.
On its own, CVS has flirted with the idea of Medicare-based home health acquisitions. Taking a zoomed-out view paints a larger and grander strategy, however, where Aetna and CVS’ visions combine.
“We are diversifying our growth portfolio with new health services,” CVS Health President and CEO Karen Lynch said in May. “We are expanding our capabilities in home health as we prepare for the 2023 launch of a post-acute transitions pilot for our Aetna membership in select geographies.”
Also in May, Aman Gill – the director of product strategy and innovation at Aetna – told Home Health Care News that home health acquisitions were “on the table.”
In order to flesh things out further, HHCN sat down recently with Dr. Kyu Rhee – Aetna’s chief medical officer – to discuss Aetna’s strategy and where home-based care fits in.
Highlights of that conversation are below, edited for length and clarity.
HHCN: We were just talking about value-based care here. And you changed that a bit to values-based care. Can you elaborate on that, and how CVS and Aetna are moving toward it?
Rhee: So, 68% of all of our contracts are more traditional value-based contracts in commercial Medicare and Medicaid. We need to keep doing that, and things like risk and quality over cost, that’s going to continue.
To me, the transition around values-based care is about this recognition that this pandemic has taught us so much about what we can do, but also where we have gaps. It’s about the values of prevention, the values of mental health, the values of primary care. The values of providing better access through things like telehealth, virtual care and home health.
Those are things we can now persist on – chronic disease management and equity, we need to keep those as part of the system. That’s what I’m implying. And in my opinion, we’re now starting to look at those measurements and those value-based contracts and starting to say, “How do we integrate our values into them differently, now that we learned so much in the pandemic?”
How was the pandemic a catalyst specifically? What can you point to from the pandemic to say, “This is only happening because of that”?
Telehealth. No question. There was a recent study in the Health Care Cost Institute that showed that in the first year of the pandemic, telehealth utilization went up by 250 times. If you saw the percentage of visits and spend that was telehealth-associated, that just rocketed up. And especially in areas like behavioral health, there’s a huge opportunity for that to persist as the way in which people get access to mental health services.
Another thing I would say is prevention access, which I talked about as a value. Look at what role we played in the pandemic in providing access to vaccines and COVID testing. If you think about it, those visits could have been with a doctor – with a facility fee, a doctor’s fee – and we were doing those drive throughs with pharmacists and pharmacy technicians, and providing access. So the home-testing market, the opportunity for improved access.
And also, I think, home health care. We increased a lot of our healthy-at-home visits as well, because we knew that a lot of those folks, maybe we would have traditionally said come to a doctor’s office or hospital waiting rooms. But we were able to go to their home, and 17% of those visits are telehealth as well. And that wasn’t the case before.
You had been going into the home before a lot as well. Especially with kidney care services, among others.
Kidney care, for sure – home dialysis, home transfusions. We have thousands of nurses who are supporting home health services. Thousands of pharmacists, who I would argue, are doing the same. They actually went to people’s homes, as well as nursing homes. They went to 40,000 sites.
If you remember, at the beginning of the pandemic, they were prioritizing the long-term care facilities, and we saw all the horrible cases being spread in those settings. But we went to 40,000 sites. Those are folks who couldn’t have gone to a doctor’s office or even a CVS pharmacy. And this is another area that I think is a huge opportunity to leverage: the role of pharmacists in virtual care services, which is part of a virtual care team, as well as home health services.
Why do you believe in ‘the care team’ so strongly? Why will future health care problems be tackled by care teams?
Health care is a team sport. I saw this firsthand as a primary care clinician – my ability to build trust with the patient was not just me as the doctor. It was my nurse, my medical assistants, my front desk staff, my nurse practitioner, my physician assistant, my pharmacist, the social worker, the psychologists, the psychiatrists. If you think about it, in every visit, there’s generally about seven people beyond the physician who play an important role in supporting one patient’s care and their family’s care.
In our virtual primary care solution, and in our thinking across all of CVS Health, we think with the thousands of nurse practitioners we have, the thousands of pharmacists that we have, the pharmacy technicians, the thousands of home health nurses, … there’s a huge opportunity for us to bring that team together and serve those patients one person at a time, one family at a time, one community at a time.
And I also like to bring this up: A lot of times, certain patients didn’t connect with me well, but if they connected with my nurse, or connected with a pharmacist or a social worker, that bridges that trust for the whole team. So that’s the benefit of a team approach. All of those different disciplines play a role in bridging trust with that patient.
Just the same way a home-based care worker can tell someone is not feeling the way they should be in the home. A primary care physician might not be able to see that.
Yes. And then the home health aide calls me – the primary care clinician – and says, “I noticed this, I noticed that.” And then, because of that trust, it comes to me, and then I can address them. And you see that so much in health care.
If you look at $1 of health care spend in our country now, 3 cents is for home health, 5 cents is for primary care. Our hope and belief is that should be increased significantly. We believe that 8 cents should go up, because it has an impact on 50 to 70 cents, right? If you invest in home health and primary care, you’re going to reduce overall health care spend and hospitalizations spend. We have to be clear that we are not investing sufficiently in home health and primary care.
And so we’re committed to finding ways to increase that investment because we believe that influences 60 to 80 cents of spend, and it’s almost got an exponential impact.
Everyone in this industry talks about the importance of technology and data. What is important technology, what is important data, to you? How do you glean legitimate insights from data?
Data starts with trust. So I suppose once again, it starts with those relationships. People generally don’t want to share data if they don’t trust you, right? Payers, providers, patients – all those stakeholders need to have trust.
An example I like to use is when I had a patient with diabetes and they brought me their blood sugar diary. They just wrote all these numbers down, and there are five pages worth of data. I saw all of this data, but it’s a little overwhelming in my 15-minute visit. When you translate that data into insights, and you apply analytics, you start seeing trends: Oh, it looks like on Sunday afternoons, you have higher blood sugars. And then they may tell you that on Sundays, they always have a brunch with the family. They’re always bringing food and maybe there’s some overeating going on. That’s the key that you need to leverage analytics into insights.
You could have analysis paralysis if you have too much data. And so what we do at CVS Health – we talked about the team – the data scientists are part of the team. So that’s the other thing that people have to realize – whether you believe or not, data science is here to stay. And analytics are here to say. So our data scientist is part of that team that looks at the data, provides those insights to a provider, to a member, to a family, so that we are now nudging people to prevent those bad outcomes. And we call that the next best action program.
In terms of home-based care providers, do you consider yourself a competitor? Or a partner?
We are partners. I keep saying this, but there’s so much need. There’s so many challenges. We all need to find partnerships, and we do need shared values. We want to partner with folks who have shared values. We are committed to partnering, we are committed to being the partner of choice as a payer for home health providers.
Amazon, Walmart and all of these other retailers are getting involved in health care and in home-based care. What are your thoughts on that? Do you think they’re going to be disrupters?
I think we’re going to work together.
It’s up to the consumer, it’s up to the member who they choose to trust. So we obviously have Walmart pharmacies in our network and Amazon pharmacies in our network. It’s not like it’s just CVS Pharmacies. So, to me, it’s ultimately up to the consumer. And that’s where I think this trend is going to move from patient to consumer.
Amazon has taught us something and Netflix has taught us something. The consumer decides. And as a result, you have Blockbuster go away, et cetera. And in health care, that is inevitable.
And we believe we’re trusted, as we’ve demonstrated during this pandemic. We’re trusted as Aetna, we’re trusted as Caremark, we’re trusted as CVS retail. And we trust that people are choosing us and will continue to choose us, and it’s their choice.
What’s the next step, in your opinion, for home based care providers? What do they need to do next?
For the home health providers, I think the inevitability of moving from patient to consumer and to home, and to hybrid, is inevitable. And so the model of care where the patient waits, I think that’s going away. Instead, it’s “the patient will see you now.” That’s going to happen.
The model is going to reverse and home health companies need to be prepared for that exciting transformation. And that 3 cents will become 15 cents on the dollar, or 30 cents. And there’s going to be hospital at home and all these other types of opportunities for home health companies, but they have to think about their data strategy, they have to think about their partnership strategy, they have to think about their analytic strategy and translating that data into insights.
Those are the ones that are going to come to the top.
I know you’re excited about a lot. If you can whittle it down, what’s one thing you’re most excited about for the future?
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