Dr. Kevin Most: CVS merging with Aetna and dogs are good for your heart

Dr. Kevin Most on the Steve Cochran Show

The announcement of CVS merging with Aetna sure has gotten the attention of many, depending on who you are the attention is focused in many directions. Let’s take a minute to understand how it may impact you as a patient. We will also discuss how it may impact the entire health care industry.

First some basic numbers. Aetna currently has 22 million patients it cares for. CVS on the other side has 9,700 retail outlets with 1,100 of them with walk in clinics.

So how will this impact the majority of us. First, those who currently have Aetna insurance will probably see some incentives to now fill all of their prescriptions at a CVS instead of Walgreens, Wal Mart or any other free standing pharmacy. That change alone should help them lower costs as they will have better buying power and incentives to push patients towards generics, thus lowering the overall cost of care.

We also will probably see a change in their clinics as well. Not only would we expect them to increase the number of clinics, as these clinics are often an alternative to a much more expensive ER visit. We also would expect them to change their focus. Currently their clinic focus is only on the ill patient looking for an alternative to the ER, now that they would be responsible for both sides of healthcare, they will actually focus on the health of their patients. The new focus on wellness is a complete change in their current business model. The healthier they can keep them, the less they use the hospital and the more profitable they could be. You would expect that the clinics would now also focus on wellness and screening. Allowing patients to come in for walk in blood pressure checks, access points for all blood work. In some cases you may even see them go after some imaging such as mammograms. Their goal would be convenience , cost as well as compliance. The goal of making the CVS clinic a point of healthcare not just a pharmacy for any of the Aetna insured patients.

Some may be concerned that it will limit choice, patients who normally get their prescriptions from Walgreens May see a “soft force” to switch to CVS. It may be lower costs, lower co pays or better tier pricing, not dictating the change but still impacting the cost to the patient. CVS will not want to pay filling charges for Aetna prescriptions filled in non CVS pharmacies, nor would they want to lose that profit. Although they will state the goal is more convenience for the patient, it may come with less choice and thus less convenient for some patients who won’t be using the other services.

Overall for patients it may be lower costs and access to services in the local community retail pharmacy that used to be completed in the physicians office.

The business side of it is interesting as well. Just the knowledge that Amazon is looking into the pharmacy and healthcare business has forced many pharmacy chains to revisit the concept of delivery and actually offer same day delivery for prescriptions. This is huge as patients hate waiting for a prescription in the retail clinic. This old school service is actually very easy now as most of the prescriptions written in doctors offices and hospital emergency rooms are now are actually electronic and not paper based. The prescription is sent to the pharmacy of choice of the patient. So we will see a dramatic change in the delivery of prescriptions . The pharmacy chain that offers this will be a huge satisfier for patients and will actually increase compliance of taking medications. Many patients hold off a few days as they don’t want to go the pharmacy to pick up a new or refilled prescription. Amazon is focusing on that, satisfaction for patients and insurers who want patients to be compliant.

This merger will also allow for healthcare data to be in one site. It will allow this company to monitor outcomes of health based on pharmacy based use. It will understand the compliance of patients and how much healthcare they use. It will also allow them to interact with clinicians as they will have data on healthcare costs in total, not just one side.

From a business side, you would think it would help them in negotiations with pharmaceutical companies for drug pricing, thus lowering costs. It would also allow them to go to companies and perhaps offer lower premium costs, if their plan to lower costs by better management of health care costs plays out.

It may also force Walgreens and WalMart to look for health insurance companies to merge with. These plays may end up with a few mega healthcare companies that may control the future of healthcare. It may limit the possibility of new companies coming into the industry. It will impact the small local pharmacy which has already been squeezed out in many areas

So you can see why this may have the attention of many , the impact will be felt by many. The business side of lowering cost while elevating care will need to be measured. The future of a few big companies controlling more of your healthcare will probably also get the attention of those concerned about fair trade.

Cardiovascular disease continues to be the leading cause of death and disability around the world. Between heart attacks, high blood pressure and strokes these account for 45% of all deaths. We know this number is not decreasing as we see more problems with obesity and high blood pressure, baby boomers who had smoked in the fast continue to have heart attacks and stroke rates continue to rise. We have discussed recently the change in blood pressure guidelines, we also recently have discussed the caloric intake of our Thanksgiving meals and holiday season that often leads to a 10 pound gain over a month. We have discussed blood pressure medication and diets, well let’s take a minute to discuss another option to treat this and for some it may be timely.

This time of year there are often discussions about getting a puppy as a Christmas gift. Often you will have one parent pro and one parent con, rarely do both think it is a good idea. As a huge dog lover, I thought it might be a good idea to give some health related ammo to the pro dog spouse as you make your case.

A study was released 2 weeks ago that showed that owning a dog lowers your risk of cardiovascular disease. Now many of you may be saying, Yeah right, small study, fake data. This is a nationwide study done over the past 12 years in Sweden, it included over 3 million individuals. It showed that if you owned a dog your risk of an acute heart attack, stroke or heart failure was much lower. The study even took into consideration socioeconomic factors. They took the large study down to a smaller group of 34,000 individuals and the data held up. This study size is 100x larger than all previous studies so it has gotten the attention of many.

So what did they attribute this decrease in Cardiovascular disease to? Interesting that the first impact the study mentions is that dogs will decrease psychosocial stress including depression and loneliness. These factors have been noted as risk factors for coronary heart disease and cardiovascular death. The nervous system which has some control of blood pressure was also shown to be quicker to respond with dog owners, thus elevated blood pressure that was not necessary returned to normal in dog owners quicker than non-dog owners. The obvious impact is the physical activity that a dog owner has when compared to a non-dog owner. They coupled this with the dog owner also spending more time in outdoor activities. This combination of impacts showed the decrease discussed, now for the non-believers, the study also showed the impact was felt the highest in single individuals. The premise there was that the activities related to the dog were not shared by a group and thus the physical activity benefit was felt by one individual. However over all in families with dogs the impact was still noted.

So let’s discuss a few other facts about dog ownership. We seem to be attempting to live in a germ free world as we think “germs” are bad, however science may be telling us something different. With all of the disinfectants we are using, we are exposed to less germs when in fact exposure to germs may not be all bad. Dogs who are loaded with germs expose dog owners to germs, yet studies have shown that dog owners get sick less often than non-dog owners. Oh and by the way, you hate when your dog licks your face, well a dogs mouth is much cleaner than a humans when it comes to bacteria. In fact if you have a choice to get bitten by a dog or a human, go with the dog. Dog bites have less infections and less serious infections than human bites do.

Did you know that dogs can actually increase your social life. Polls have shown that people trust others who have a dog more than they do the random person they walk by on the street. Think about that, if you are walking down the street and you see someone walking a dog, you are more likely to interact with that person than you would a person who is walking without a dog. You may talk to them, stop to see the dog or at least acknowledge them. Having a dog allows for more social interactions

I am not sure if you know but we have dog therapy at just about every hospital. This therapy is usually dog related, where we bring trained dogs in to give comfort to those hospitalized. Numerous studies have shown that even a short 15 min visit to a hospitalized patient makes a huge impact. It often lowers the need for pain medication, lowers anxiety and has an impact on blood pressure as well.