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Comment by rdl | Hacker News Reader

If this turns every CVS into a uniform, inexpensive office/urgent care/etc., particularly with telemedicine, I'll be happy -- the "minute clinic" stuff already provides cheaper and more convenient access to care, but CVS+Aetna+some kind of EHR could do something amazing.

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Aetna is a healthcare payer (or commonly known as a 'carrier') and CVS is a healthcare provider (specifically 'pharmacy') and minute clinic's are also providers (specifically 'care').

Aetna doesn't add any more to the equation of CVS other than streamlining payments. It's only interesting if you use Aetna I guess, but you can generally use CVS pharmacy + minute clinic with your insurance provider today.

General high level overview of this:

https://www.bcg.com/en-us/industries/health-care-payers-prov...

Isn't it possible that the two companies being under the same management could have a second-order effect of expanding their Minute Clinic business? That is, because Aetna is part of the same company, it would be less costly for patients to visit MC since the prices that insurance providers usually have to negotiate with providers would go down enormously (to cost + profit instead of cost + MC profit + Aetna profit), thereby bringing more patients into the fold.

That’s only if MC has huge margins, which is doubtful. They already have to negotiate with every carrier.

Vertical integration cuts costs.

costing savings isn't as immediate or apparent as horizontal merger, otherwise more companies would be doing it. Perhaps it makes more sense in space where there are fewer players, but in healthcare as an overall pie is huge.

Depends. Kaiser is a great example of this (its a closed loop payer and provider) but it has a huge network within certain regions and doesn't cover nationally. The problem is that CVS via pharmacy retail and MinuteMan only satisfies a part of the whole care provider package. Kaiser on the other hand has it's own providers that carry everything from head to toe (no pun intended). That's why I don't see why this would be such a big deal.

Given that currently around 1 out of 9 locations has a minute clinic that seems unlikely.

https://cvshealth.com/about/facts-and-company-information

When I had Aetna, they didn't even cover getting a flu shot at the pharmacy. Maybe they changed that, but it's dumb, they covered it 100% using primary care.

I can attest to the fact that Aetna does cover flu shots now.

Flu shots are required to be covered in all U.S. insurance per the ACA. The point was that Aetna was requiring the more expensive (for them!) visit to a doctor's office for them to cover it and wouldn't cover it happening at a pharmacy.

When I had Atena they did cover pharmacy flu shot but only at one specific pharmacy. It's been years but if my memory serves right think I had to go to CVS to get the flu shot rather than my usual Walgreens.

probably not more expensive for them... to go to your doctors office, you need to make an appointment, take time off work, etc.

To go to a pharmacy, you can stop by on your way home or do it on the weekend.

By making it inconvenient, you reduce the number of people getting a flu shot... and I would bet that more people drop out from the inconvenience, than the extra amount it costs aetna when you go to the doctors office.

But if just one of the people insured by Aetna ended up in the hospital due to complications from the flu due to not getting a flu shot, the amount of money they'd have to pay for the hospital stay would pay for hundreds of flu shots.

The insurance provider doesn't care how much it costs. The ACA states that the insurance provider must spend 80% on services. So as far as they're concerned, the higher the costs of healthcare the more money they get to keep. They just can't let costs skyrocket faster than they're able to increase your premiums.

The market is a horrible contrivance, and insurance is fundamentally unworkable in a market, unlike actual services and products where you know what you're getting and when you'll need it…

But that said, do you have even the tiniest bit of evidence that insurers actually do what you're saying in order to keep their costs up per ACA requirements??

There's all sorts of shenanigans in the industry, but your speculation sounds far-fetched. Remember Hanlon's Razor…

Occam's razor is a better fit here. In a world where they have to return any cost savings to the insured, what is the incentive to reduce costs?

In theory, competitive rate setting for premiums. Hasn't worked out that way in many places though.

This is the fundamental flaw in the ACA. It did nothing to increase competition. In fact, increased regulation pushed some competitors out of the market. I can't tell whether this was a fool's errand or an intentional destruction of the market, pushing us towards socialization.

The ACA states that your insurance provider must spend 80% of their premiums on health care. The doctor is more expensive, so the health insurance provider is allowed to keep more nominal dollars.

Although true, I doubt that's the reason since stuff like this was common pre-ACA.

The truth is that everything that a payer pays for is done through contracts. Payers will often default to a specific provider because the contract covers it and they don't have a contract for other providers.

In terms of the cost, back-end rebates often bring it down. Also, this particular contract may cost more for a flu shot, but save them even more for other procedures.

I'm sure Atena has/had a ton of different plans (especially in different states). Theres PPOs, HMOs, POSes, EPOs, high deductible, etc. so any general comments about what Atena does and doesn't cover won't always apply.

And I do like that the pharmacy is next to the docs office.

Is there a good way to do telemedicine now? I can’t get over the awkward factor but if it saves money.

I have used amwell with great success, recently. I have no affiliation with them, and I am paying them for their services, but my experience was top notch, and I have a PCP through them. I have yet to get my insurance to process automatically, but I just paid with their FSA VISA card and I'm doing an offline bill to submit. Many states REQUIRE covering telemedicine, even for Medicare/Medicaid in some cases.

Telemed from a minute clinic to a specialist is different than telemed from home to a primary care provider. The former is a lot easier to make work.

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