Going Vertical: Acquisition Magnitude, Pace to Achieve Integration Heat Up

CVS announced its acquisition of Signify Health on September 5, 2022, cementing the company as no longer just a pharmacy chain but as a health care sector conglomerate in the home-provided services business.¹ Notably, nowhere in the CVS Health–issued statement is there any mention of “Aetna” or “pharmacy.” CVS Health cited a desire to solidify capabilities in value-based care delivery as the motivating force behind the purchase.

Walmart Floats Trial Balloon With UnitedHealth Group

Walmart announced a partnership with UnitedHealth Group (UHG) on September 7, 2022, to provide analytics and other support from UHG’s Optum suite of capabilities to assist with Walmart Health deployments.² This partnership is the first major integration with a health plan since Walmart’s teaming with Humana on Medicare enrollments. Notably, “pharmacy” is not mentioned in the statement by UHG, but the rationale for the partnership is to offer better and more integrated plan provider value-based care delivery.

Amazon Gets Into Primary Care, for Real This Time

Amazon announced the purchase of One Medical in July 2022; such a bricks-and-mortar acquisition has not occurred since it bought Whole Foods in 2017. Yet One Medical has qualities with which Amazon is familiar: analytics, data collection, and devices, plus a subscription model, for which customers pay $199 per year to access same-day in-person or virtual visits. Notably, “pharmacy” is mentioned in the Amazon/One Medical media coverage, with PillPack as a supporting offering.

Better Late Than Never, Rite Aid Makes Its Medical Care Play

In May 2022, Rite Aid and Homeward announced a partnership to focus on the accessibility of medical care in rural pharmacy locations (in the parking lot to start with).³ This follows already-in-place medical integration efforts by CVS-HealthHUB-MinuteClinic; Kroger-The Little Clinic; VillageMD-Walgreens; and Walmart Health. Notably, the news release mentioned the importance of pharmacies in communities.

Buy vs Partner: Regardless, Owning Patient Journey Is the Future

Some have the cash to spend billions to buy, whereas others choose to partner or start piloting first. Regardless, the prevailing motivation behind these acquisitions and partnerships is to own the patient journey. Much like Apple’s ecosystem, everything from form to function is designed to keep customers in that system. From content procurement to devices and software on down to the charging method, the goal is to keep customers buying the same family of products. The entry points into the health care system are home health, the pharmacy, and primary care. All 3 are being put together en masse based on a bet that patients will prefer a more accessible system and that value-based care, at its core, is keeping patients away from hospitals and specialists, also known as health systems. There is a tectonic battle between the old guard of providers and the better-funded new guard of Wall Street providers.

Chatter Abounds About Collaborative Practice Agreements

The question remains, what does all this have to do with community pharmacy practice and pharmacists? I was heartened to hear recently that at least one pharmacy group and likely another are working to grant credentials to pharmacists and creating collaborative practices agreements between integrated primary care providers and pharmacists. Let’s hope this leads to using pharmacists as valuable health care providers in an opportunity-based health care services delivery setting.

We Have Been Saying Delivery of Professional Services Is the Future for More Than 3 Decades

It turns out this was right in the end, but the timing was not. It did not happen in the 1990s, 2000s, or 2010s. It will occur in the 2020s and be precipitated by 2 factors: a pandemic that fundamentally changed patient and purchaser perceptions about pharmacists and pharmacies; and value-based care delivery leading to consumers, employers, and taxpayers becoming fed up and asking for sane, economical options that provide tangible outcomes. They say that it is darkest right before the dawn. Maybe the dawn is on the horizon.

ABOUT THE AUTHOR

Troy Trygstad, PharmD, PhD, MBA, is the executive director of Community Pharmacy Enhanced Services Network (CPESN) USA, a clinically integrated network of more than 3500 participating pharmacies.

REFERENCES

1. CVS Health to acquire Signify Health. News release. CVS Health. September 5, 2022. Accessed September 28, 2022. https://www.cvshealth.com/news-and-insights/press-releases/cvs-health-to-acquire-signify-health

2. Walmart and UnitedHealth Group collaborate to deliver access to high-quality, affordable health care. News release. UnitedHealth Group. September 7, 2022. Accessed September 28, 2022. https://www.unitedhealthgroup.com/newsroom/2022/2022-9-7-wal-mart-collaborate-affordablehealth-care.html

3. Rite Aid and Homeward partner to support seniors in underserved communities. News release. Homeward. May 31, 2022. Accessed September 28, 2022. https://www.prnewswire.com/news-releases/rite-aid-and-homeward-partner-to-support-seniors-in-underserved-communities-301557433.html