By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
“If at first you don’t succeed, try, try again.”
During the first half of 2017, two mergers, each pairing national health plans—Aetna with Humana and Anthem with Cigna, respectively—were blocked by two federal judges, both of whom concluded that the mergers would reduce competition in the health insurance market and, therefore, raise prices.
Departing from the horizontal merger approach, three national health insurers are now involved in proposed or possible vertical mergers. CVS Health announced its intent to acquire Aetna in December 2017; Cigna announced its plan to acquire pharmacy benefits manager Express Scripts in March 2018; and Walmart is reportedly in acquisition talks with Humana. Because of their size, the interesting value delivery chains they would create, and potential synergies, these corporate combinations have been described as disruptive and industry game-changers.
From a health policy standpoint, what has contributed to these mega-mergers?
First, the specter of a single-payer healthcare system—as most ardently promoted by Sen. Bernie Sanders (I-Vt.)—has been greatly diminished by the election of Republican Donald Trump as president in 2016, continued Republican majorities in both the House of Representatives and the Senate, and perhaps most saliently, the passage of the Tax Cuts and Jobs Act of 2017 (TCJA) in December 2017.
It is a truism in Washington, D.C. that taking back something that has been given to the public is hard, if not impossible. Since a single-payer healthcare system would clearly entail a major expansion of the federal government that would require not only the repeal of the TCJA’s tax breaks for individuals and corporations, but also the imposition of additional tax increases, it would appear to be a political impossibility for at least until 2021.
Second, Medicare Advantage (MA), Medicare’s managed care program, increasingly is where the action is for health plans. Congressional Republicans strongly support MA, and the program is gaining in popularity with Medicare beneficiaries. The Centers for Medicare and Medicaid Services projects that 20.4 million people will enroll in MA for 2018, an increase of 9 percent over 2017, about three times faster than the growth of the total Medicare enrollee population. More than a third (34 percent) of Medicare beneficiaries are enrolled in MA.
The proposed mega-mergers involving Aetna, Cigna and Humana secure control of significant shares of the Medicare population, including sizable shares of the MA enrollee pie.
Through grants, sponsorships and employee volunteerism, Aetna and the Aetna Foundation are working to help improve the health of children and adults and to make the healthcare system more equitable and effective. Garth Graham, M.D., M.P.H., is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses some of the most pressing issues he’s seeing, as well as the Aetna Foundation.
People are using wearable technology and smartphone apps for just about everything these days. How do you see the Aetna Foundation’s commitment to technology playing a role in reshaping health?
Digital health technology provides a powerful tool to reach people with real-time health solutions that fit easily into their daily lives. In early 2014, the Aetna Foundation significantly expanded its commitment to digital health technology and mobile health solutions. Our $4 million, three-year commitment will help to implement and evaluate technology innovations that can help reach underserved communities with health solutions.
But does this technology really impact underserved groups?
People from all walks of life are increasingly relying on technology and we are increasingly seeing technology being utilized more among underserved communities, which offers an opportunity for direct education to individuals that have been hard to reach in the past. In fact, adults living in poverty account for 56% of cell phone-only households (CDC), making mobile technology a powerful equalizer for low-income communities. One example of our work is the Institute for eHealth Equity’s Text4Wellness program that focuses on reaching African American women ages 19 to 55 in Cleveland, Ohio. Women are a key audience because they not only make decisions about their own health, but are also more likely to be the decision-makers in their homes regarding food choices, meal preparation and wellness activities. Through programs like Text4Wellness, we are helping underserved communities access the tools that they already use daily to impact their health.
Garth Graham, M.D., M.P.H., specializing in cardiology, is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses the Aetna Foundation, improving quality of care, how the health IT community continues to change, how can it best be used as a positive tool for better health outcomes, even at the individual level.
Tell me about the Aetna Foundation and your role within the organization? How does the Foundation impact healthcare community?
The Aetna Foundation is the philanthropic arm of Aetna, Inc. funding a number of activities across the country that promote thought-leadership and community-based impact as well as research around improving health outcomes. As the Foundation’s president, I oversee the philanthropic work, including grant-making strategies aimed at improving the health of people from underserved communities.
Overall, at the Aetna Foundation we seek to impact the healthcare community by supporting research and organizations focused on improving the health and wellness of individuals throughout the United States.
How do you go about working to improve the health status and quality of care of the individual and community?
Our Digital Health Initiative is the most recent example of our efforts to fund both national and local programs that are striving to limit healthcare disparities among vulnerable populations, as well as increase positive health and wellness outcomes for individuals. Through this initiative, we are supporting technology that can empower individuals with the convenience and control to meet their personal health and wellness goals.
We hope that by arming individuals with the best possible tools to improve their health, we can ultimately build healthier communities.