The Path from the ACA to CVS/Aetna

The Affordable Care Act has broadened Americans’ access to care in seemingly durable ways, chummed the waters for a feeding frenzy of healthcare industry consolidation, and sped up our (still achingly slow-moving) transition from a fee-for-service system to one that rewards value and quality of care. So what’s next for American healthcare?

A year ago, I would have answered that question with something like: Obamacare will be repealed in pieces or as a whole, or else it won’t, and then apart from an orgy of deregulation and the odd Presidential Tweet blasting some poor pharma company or raising prices, nothing will happen in healthcare for the duration of the Trump Administration.

And I would have been very wrong, because instead of stasis, we have an anarchic free-for-all shaping up in the U.S. healthcare marketplace with radically different models of care provision competing for scale. CVS wants to make retail pharmacies the “front door” of American healthcare! UnitedHealth is building a world-beating provider network! Amazon might just bum-rush the pharmacy benefit managers (PBMs) and disrupt the dickens out of drug distribution! Or maybe they’ll buy an insurer, or plant an artfully upscale, exorbitantly pricey urgent care center in every Whole Foods store! Who knows?

There’s a common denominator in all of these players’ schemes though: Using emerging technologies such as apps, video chat, and sensors embedded in phones, watches, and other wearables to close the gaps in our fragmented healthcare system and deliver a better, more frictionless customer experience. A few factors drive this emerging consensus:

  • The shift towards rewarding value over volume in healthcare has everybody from insurers to IDNs looking for ways to improve patient satisfaction, keep patients on therapy, deliver better patient outcomes, and lower hospital readmission rates. The rise of the ACO model, in particular, incentivizes payers and providers to keep patients in-network since population health puts them on the hook for outcomes either way. That means providing a better patient experience and keeping patients in the loop and engaged in their care.
  • Consumers are increasingly in control of their care—they’re doing their homework online, looking up symptoms before a visit, and comparing treatment options afterwards, prescription in hand. One in five U.S. adults use their smartphones to look up information at the doctor’s office (Source: DRG Digital/Manhattan Research, Cybercitizen Health® 2017).
  • Consumers are also bearing more and more of the upfront costs of care in the form of higher deductibles, so they’re shopping around. And they expect more from the healthcare customer experience—three in five expect healthcare companies to provide them with the same level of customer service that they get from (Source: DRG Digital/Manhattan Research, Cybercitizen Health® 2015).

You can see why Amazon is eyeing healthcare. The eCommerce revolution it epitomizes has reset our expectations of the customer experience across any number of sectors. Each of these players—CVS/Aetna, UnitedHealth, and Amazon, not to mention Apple, Google, IBM, and Microsoft—sees opportunity in meeting these new expectations and providing a healthcare user interface that just works.

  • Matthew Arnold

    Matthew Arnold is Principal Analyst at Decision Resources Group (DRG), a part of Clarivate. Matthew covered the pharmaceutical industry as a journalist for over a decade before joining DRG, where he has worked on the company’s studies of patient, physician, and payer multichannel behavior and preferences for the past 8 years.


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