To understand the potential impact on patients of CVS Health Corp.’s proposed $69 billion takeover of Aetna Inc., set aside the high-level analyses and consider for a minute the particular experiences of one patient.
He’s a man who donated a kidney to his teenage son after the boy’s recovery from a rare cancer was sidetracked by life-threatening complications. And just a year later, he broke his neck in a skiing accident, which caused permanent nerve damage and chronic pain. These experiences changed him.
That man is Aetna chief executive officer Mark Bertolini. There’s no doubt the merger will benefit Bertolini-as-CEO: He reportedly stands to reap a staggering $500 million windfall. Less clear is whether the deal will deliver, in the companies’ words, “best health” to individuals in the kinds of crises experienced by Bertolini-as-caregiver-and-patient.
I’d like to suggest that the key to this merger’s ability to achieve its potential lies in the companies’ additional promise to provide “a health care platform built around individuals.” With the right foundation, this new insurer-retailer-pharmacy axis could promote a profound shift in the power dynamic of existing health care relationships.
CVS and Aetna have both been leaders in digital health, whether it’s a 3-D view of the pharmacy available as an iPad app from CVS’s Digital Innovation Lab or Aetna’s aggressive focus under Bertolini developing the Resources for Living app into a multifunctional consumer tool.
Senior management of both companies have been responding to a sea change in the delivery of care that’s often overshadowed by the political battles over health insurance. Technological change along with new payment incentives that reward maintaining wellness as well as treating sickness have been shifting control away from the traditional care system. Emerging instead is a shifting constellation of relationships, shaped by each individual’s circumstances, that I’ve called “collaborative health.” Doctors, hospitals, health plans, online communities, tech companies, and entrepreneurial startups are all scrambling to secure their place.
It’s a struggle similar to what’s occurred elsewhere. As noted by Tim Berners-Lee, creator of the World Wide Web, in the digital age individuals have the ability to “integrate data from diverse aspects of life — financial, medical, home automation — [and] control what to share with whom.”
Here’s where CVS-Aetna could break through health care’s notorious resistance to change. Rather than pursuing the typical path of trying to corral patients within its own information silo, CVS-Aetna could instead empower new consumer relationships that deliberately dissolve the old boundaries. Those relationships should be based on three principles: shared information, shared engagement, and shared accountability.
Shared information means that consumers, as partners, should have complete access to all their medical information — just as Bertolini struggled to do when his son fell sick. That includes the doctors’ notes from the office or the hospital; pharmacists’ records; and all of the insurance company’s interactions with providers. Moreover, in a platform truly built around individuals, such information must be portable, meaning I can take it to Walgreens, the Mayo Clinic, or even UnitedHealth. It’s mine — it doesn’t belong to a health care organization or company.
Shared engagement means that CVS-Aetna commits to electronically engaging with whomever I choose, whether it’s a yoga center — as Bertolini turned to after his accident — a physician, or a respected online community, such as PatientsLikeMe.
Finally, there’s shared accountability. How can I collaborate as an equal with multibillion-dollar entities all eager to “engage” me on their own terms? A merged Aetna-CVS could use its clout, and Bertolini’s personal experiences, to pioneer the hard work of figuring out who’s responsible for making things go right, who’s responsible when things go wrong, and what role its fellow mega-organizations should play. This is especially important as health care organizations, whether insurers, providers, pharma companies or others, are increasingly combining into even larger and more intimidating entities.
The three principles I’ve outlined don’t guarantee “best health,” but they do give patients far more effective tools for trying to achieve that goal themselves in the relationships they choose for themselves. The CVS-Aetna combination could mark the beginning of a bold new model of sharing power, or it could provide just one more example of big companies finding new ways to hoard it.
Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, Ill., an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine, and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age.”