In acquiring Aetna, CVS Health Corp. promoted the value of
integrating health benefits with the company's thousands of existing pharmacies
and retail clinics. Other health insurance carriers seem to have taken heed, as
national health plans such as Anthem, Inc. and Humana Inc. recently have sought to
establish or expand clinics in a variety of markets.
Background:
- Anthem is contracting with CareMax Inc. "to build
medical centers in areas where Anthem will offer a value-based care model
to improve patient outcomes," per an Aug. 13 press release.
- Humana will expand its Humana Neighborhood Centers line
of clinics, which already operate in Asheville and Greensboro, to several
other North Carolina markets including Charlotte.
What industry experts say:
- "What I like about these new things is if you can
open the door to a non-member, and offer virtual health or community-based
care, or specialty [pharmacy] access, suddenly you're opening your door to
a much broader swath of potential members. You can't really call them
members, but they're participants in your ecosystem," says Ashraf
Shehata, KPMG's national sector lead for health care and life sciences.
- "That's where the breakthrough thinking of this
will work, if I can essentially separate retail-based services from my
general plan design," Shehata explains. Plans will get value from
retail clinic investments if they "can use that as a hook to get
people in and actually sign up for a plan that they're eligible for."
- "The news of the collaboration between Anthem and
CareMax comes as we have seen a growing push for value based care (VBC)
arrangements, and a proliferation of risk bearing primary care entities
new to the public markets….We expect these models and partnerships to only
accelerate with debate likely to center on geographic expansion and scalability,
consistency of delivering results, and risk adjustment," Citi analyst
Ralph Giacobbe wrote in his Aug. 13 note to investors.
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