The Impact of Consolidation on Healthcare Stakeholders

Bruce Feinberg, DO: What’s the impact on other stakeholders, impact on hospitals, impact on specialty physicians? Are there downstream problems for other stakeholders here?

Mark S. Soberman, MD, MBA, FACS: I think certainly, if I were a primary care physician, I’d be worried. As a specialist, perhaps not so much. As a hospital, depending on how much I’ve invested in primary care, it’s a plus or a minus.

Bruce Feinberg, DO: The hospital is no longer next to the Walmart; they’ve got the new version.

Mark S. Soberman, MD, MBA, FACS: Not now.

Bruce Feinberg, DO: You go in and get your groceries, and if they check your A1C [glycated hemoglobin] and it’s not right, you actually move next door. Not yet, but the future?

Mark S. Soberman, MD, MBA, FACS: Not yet.

Bruce Feinberg, DO: Maybe.

Mark S. Soberman, MD, MBA, FACS: Anything’s possible.

Bruce Feinberg, DO: That takes us to a place that raises the question, If we look down the road 5 years—because all of you have crystal balls and you’re so good at this—is this going to be one of those waves that we talk about? I think about where we started earlier in our talking about the history, and we had all these practice management companies and they all went away. None of them survived. I’m not sure none of them survived, but most of them didn’t survive. But is this a wave that is successful? Is it transformative? And 5 years down the road, what do we see differently? Is it too soon? Are there enough data where we’re going to know something different in 5 years? That vision this might create, a change in chronic disease management, will it happen or not happen?

Dana Macher: I think it will. I think it happens. I don’t think that this is going to go by the wayside, mainly for the reasons that we’ve been talking about: 15 or 20 years ago, the data capabilities just weren’t there. Now they are, and there’s the opportunity to make this incredibly efficient based on data to actually reduce costs. I actually think that it is transformative, and it’s not going away.

Mark S. Soberman, MD, MBA, FACS: The other piece of this is that—and I know that we’ll be talking about this at some point a little bit further on in the conversation—the large employers who pay for most of the healthcare in this country have a vested interest in this. We’re starting to finally see all these innovative relationships and constructs, and the fact of the matter is, for many companies, the single largest line item in their budget is paying for the healthcare of their people. They have a vested interest in removing absenteeism or presenteeism and having a healthy workforce. We’re starting to see the payers start to have a voice, and I think that will continue to drive, as Dana said, this wave.

Michael Kolodziej, MD: But for this to occur…It’s a good story; it’s an interesting, fascinating, cool story. But I have become so cynical that anything can get done in 5 years. We have to recognize that there are a couple of things that are going to have to happen for this to actually catch on. Number 1: We’re going to have to look at health outcomes and document that this model in fact represents an improvement in health outcomes, ideally across the population. Number 2: We obviously have to pay attention to cost.

It’s funny, when I was at Aetna and somebody came to me with what they thought was the greatest new idea, I’d always look at it through the lens of, Is this just going to be another add-on cost? For example, when a family member takes their kid to Walmart for an ear infection. Mom isn’t happy. She goes to the pediatrician tomorrow. That has accomplished nothing. It’s really accomplished nothing. I think that there are major challenges. Interoperability and the transfer of medical information between physicians who have ownership over the management of that patient and these almost direct-to-consumer opportunities need to be resolved. It needs to be solved quickly.

How this gets packaged into a benefit as it’s sold to the self-insured plan sponsor or to the individual member needs to be sorted out. How do you price it? All that other stuff. I think there are huge challenges to this moving forward. But in terms of concept, I think it’s really interesting, I really do.

Dana Macher: Yes, Mike, I agree with you. There are major challenges, but I think that some things won’t change. I was speaking to a payer not too long ago, and we were just talking about site-of-care shifts, specifically in oncology. We were talking about infusions, and he said, “All oncology care is going to be given in the home by 2028.” That makes you pause, but that’s 10 years from now. Think about that, especially as our rising population, the millennial population, likes convenience. Maybe it’s a little bit of a lightning rod to mention millennials, but it’s very true. It is much, much more consumer oriented, and I think healthcare has to go in that direction. Not to say it will not be challenging. I think it absolutely will, especially when you think about our administration and the challenges that we have there, which is a whole other topic about difficulty. But I think it has to get there. Whether that’s 5 or 10 years, it’s going to get there.

Michael Kolodziej, MD: There’s another element here that could significantly impact moving in this direction, and that is that the doctors hate it. They are so incredibly intimidated that this kind of merger is going to do nothing but empower the health plans to exercise increased leverage on their day-to-day life that I can already hear Barb McAneny in the back of my head, what she’s going to say about this. I know what she’s going to say about this. I think, in fact, the AMA [American Medical Association] has come out strongly against the Aetna/CVS deal. Physicians could make it really hard for this kind of thing to happen.

Mark S. Soberman, MD, MBA, FACS: They could, but at the same time, look at who our largest payer in the market is. It’s the federal government. We have a hard time pushing back against them.