A Big Deal for The Ages

Following the CVS bid to acquire Aetna for $69 billion, there has been frantic speculation about the implications of the blockbuster deal. What will it mean when the corner drugstore owns your insurance plan?

To understand this complex undertaking, three questions emerge:

What does the deal mean?

Most obviously, it shows what the market is saying about where the money is in our 21st century. More specifically, it shows where the money is to be made. On the surface, it looks like “healthcare,” but dig a bit deeper and we find something more profound, inexorable, and less politically convenient: the aging of our society.

Any serious market analysis of trends, not only in the US, but also globally, will find that the 60+ cohort is the largest and most rapidly growing population segment. This market analysis will also reveal that these “seniors” control the wealth. In the US, 70% of disposable income is held by those over 60. With two billion people over 60 worldwide by mid-century, expect to see more daring corporate strategies designed to capture the opportunities created by market analysis through the aging population strategic lens.

Why did the deal happen?

It’s no secret that more “old people” means more acute healthcare. Here in the US, spending on acute healthcare has been fuel to political fire for over two decades, and there’s no reason to expect the flames to die out. As the population ages, the demand for healthcare will continue to increase, and so too will the supply, along with its associated costs.

For CVS, the calculus is straightforward: they have proprietary insights into what older consumers want and need, and they are sitting in a position of incredible market strength. As such, in acquiring Aetna, they’re carving out a space where they can increase their consumer data, broaden and streamline the services they offer, and establish themselves as the nucleus of a vast, disparate and evolving healthcare system.

But, what’s next?

While some of the details remain fuzzy, one is clear: CVS is doubling-down on its push into “wellness.” This should open the door to explore three new areas: remote care; medication adherence; and elder care, all essential to quality of life and cost management in an aging society.

Remote care: Expect CVS to integrate health technologies through “remote care monitoring and delivery” into their stores. When you head to your local CVS for toothpaste and your monthly prescriptions, you could also use remote care to track your cardiovascular health, monitor your diabetes, or even get expert diagnosis of that skin rash. The efficiencies gained through such activities at a CVS instead of going to your hospital, clinic, or doctor, even as the technology migrates into our homes, are both obvious and profound. And as remote care becomes our standard of care, it will be our first true revolution in care delivery since the 18th century when community care was centralized in the creation of the hospital. Memo to CVS – as you complete your deal, you might want, fairly immediately, to talk to some of the world’s most innovative technology companies to figure out how to further extend the value you are creating.

Medication adherence: Ask anyone with a career in healthcare about the industry’s single biggest and most intractable problem, and one answer will rise above the rest: medication adherence. Even the world’s most incredible breakthrough medicines don’t work when people don’t take them. It seems too obvious to even state, but the data on lack of adherence is stunning. For older adults who take multiple medications, the problem intensifies. Take stroke – horribly crippling and possibly deadly – yet, here in the good old USA, a full 12% of people do not take their stroke medication at all after they fill or buy their prescription. And, if you look at the multiple factors associated with this non-compliance, age is at the very top of the list.

Like the opportunities with remote care, higher rates of adherence could save the overall healthcare system untold sums. When people don’t take the medications that keep them well, it is common for costly procedures and interventions to follow. By one estimate, lack of adherence costs the U.S. healthcare system $289 billion – more than twice what cancer costs the country each year.

And, surely one of the reasons for all that debt on the Aetna balance sheet is the inability to manage patient wellness, which could certainly be enhanced by improving adherence even incrementally. It’s possible to imagine how, if CVS brings remote monitoring into the same physical space where prescriptions are filled and re-filled, adherence could nudge upwards.

Elder care: If the 60+ population is the fastest growing segment globally, the fastest growing sub-segment is the “oldest old.” As lives stretch to 80, 90, and even 100 as a matter of routine, the demand for caregiving skyrockets. Moreover, as adult children or elder spouses act in a caregiving capacity, their own health deteriorates.

But what if the corner store brought together earlier detection and diagnosis through remote care and other enablers of wellness? What if the many stops along the healthcare continuum, including access to home care information, were consolidated into a single space? What if a 65-year-old could check her cardiovascular health while buying the weekly supply of adult diapers for her mom and in the process CVS was helping her find that additional care? What if, for example, a 35-year-old could have an annual wellness visit while bringing his mother in for her dermatology check-up?

What if…CVS helps us to re-imagine healthcare through the lens of enabling a healthier and more active aging for all Americans?

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