Mergers are in the air in the healthcare industry.
Earlier this month, the CVS Health pharmacy chain to buy insurance provider Aetna Inc.
If the $69 billion deal is approved, it will be the largest U.S. health insurance consolidation in history.
Just days later, UnitedHealth — America’s largest health insurer — a $4.9 billion deal to purchase DaVita Inc.’s primary and urgent care services.
These blockbuster deals signal a major shift in the healthcare field — one that could have significant repercussions for consumers.
Expanding the field for shareholders
Experts say these mergers are an indication that large companies have saturated their traditional markets and are looking for new ways to increase their valuation.
“CVS’s opportunities for growth on the traditional retail pharmacy side are pretty limited, and so this gave them and their shareholders the opportunity to continue to grow the company by moving more closely into the insurance space,” Jerry Senne, vice president of value-based care at Orlando Health, told Healthline.
The CVS-Aetna and UnitedHealth-DaVita deals capped off a busy year in healthcare mergers.
“UnitedHealth, through their Optum subsidiary, has done a lot to move into the provider space through their acquisitions in urgent care, physician practices, and in the area of surgery center operations. They also have the largest pharmacy benefit manager, so it competes directly with CVS in that space,” continued Senne. “I would say that United and Aetna are now making a pretty significant play in that direction.”
Senne says the UnitedHealth-DaVita merger isn’t the first time an insurance company has expanded its holdings.
“Humana owns home care assets while Sigma owns some physician practices and some facility assets as well, so it isn’t unheard of for payers to move into the provider space,” he said. “But this is certainly a very large-scale transaction.”
How will it affect consumers?
It’s too early to know exactly what form these mega-mergers, if approved, will take.
Advocates may see value in the possibility of a one-stop shop for insurance and healthcare, while opponents could see a monopoly brewing where companies can set their own prices and face little competition.
Michelle Napier, chief revenue officer at Orlando Health, says the consolidation of a major pharmacy chain like CVS with an insurance company could make information more accessible for consumers.
“The ease of the electronic tools of information that those companies bring, they’ve both invested a lot of time, energy and resources in electronic tools for the consumer,” she told Healthline. “So having them come together really does set the stage for many consumers having much more transparent information than they have today. To have the combination of medical care and prescription care, all the way through your specialty pharmacy, is pretty attractive.”
Senne sees three key ways that the CVS-Aetna merger could be attractive to consumers — assuming the merger is consummated and the companies can deliver.
The first, says Senne, is cost.
“You would believe that consolidation of a very large insurance company and medical claims processor with a pharmacy management company and claims processor would achieve some savings that would ultimately carry back over to the consumer,” he said.
The second area is healthcare consumerism, providing the opportunity for consumers to purchase and access healthcare through the 7,700 CVS locations across the United States.
“The last, which is the Holy Grail, I think, is to try to eliminate the degrees of complexity and fragmentation that there are in the healthcare system,” said Senne. “So by bringing these two large providers together, there would opportunities for simplification for consumers.”
Kristine Grow, senior vice president of communications for America’s Health Insurance Plans (AHIP), told Healthline in a statement:
“Health insurance providers are committed to improving and protecting the health and financial security of the people they serve. With that commitment, insurance providers are working to make healthcare more affordable, provide more choices, make care more convenient and accessible, and make the health care experience more satisfying.”
Trend likely to continue
“2017 saw a lot of merger activity and we continue to see that,” said Napier. “We’ve trended in the past with these large companies coming together — some successful, while some did not complete the transaction. But I do think that we’re going to continue to see some of these economies of scale, and this synergy really focused around consumerism and the distribution channels of how people seek care. I think we’re going to see more of that.”
The announcements signal a clear intent for health insurance companies and healthcare providers to consolidate their assets — even if the deals ultimately need to be tweaked in order to gain final approval.
“I think we’re going to see more of this selective asset purchase, by either payers or large healthcare concerns,” said Senne. “As the lines blur between payer and provider, I think that’s likely to be the case.”
Senne says a future trend could see companies taking a more regional approach.
“I think you could also see insurance companies partner with large regional healthcare systems or regional insurance companies, the way that Blue Cross plans partner with healthcare systems,” he said.
Whether it’s these smaller regional companies or massive mergers of Fortune 500 companies, Senne says the trend of mergers and acquisitions will probably continue.
“The reason is that, so long as it’s grounded in value — which is reducing cost, reducing complexity and increasing quality for providers — I think the opportunities there are almost unlimited in the United States.”