Mark Bertolini
As you may have read, Aetna is the target of a much-discussed but as yet unconfirmed acquisition deal from CVS Health. Aetna CEO Mark Bertolini declined to comment on the speculation in a third-quarter earnings conference call with analysts. But he did offer a window into how the health insurer thinks of the future of healthcare delivery in alternative settings, such as in the home and at CVS Minute Clinics. He also shed some light on the insurer’s growing use of data scientists and why anticipating tax reform by Congress is like “walking through Hell” for businesses like his.
Data analytics will increasingly shape its business model and will be used to help make decisions across the business, Bertolini said in prepared remarks.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
He explained on the call that the diversity of reusable and disposable databases and the reduced expense of analytics software in the past five years have played a role in embracing data analytics.
“We have geared up pretty significantly in the numbers and types of people we have hired around that,” he said. “Techies love having a hard problem to solve, so we are really pushing after that.”
Bertolini noted that the insurer is using data analytics in the commercial group market to better understand how to approach employers in different market segments. Detecting and rooting out fraud is another application of its analytics tools.
Using lower cost venues of care delivery in or near the home is also an area of interest, particularly as Bertolini offered up the statistic that, on average, 41 percent of healthcare costs are coming from consumers’ pockets.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
“It is our view that this is the next big arbitrage — we don’t need to own it but we need to find the right economics to make the relationship work for both the deliverer of care and for us.”
One analyst from Sanford Bernstein questioned how big an opportunity these lower cost care settings present for Aetna.
“..I would not think of it as pure arbitrage like taking someone out of the ER and moving them to a Minute Clinic. I think you have to think of it as keeping people away from the medical-industrial complex by offering better services in the home by meeting social determinants of health, which are big drivers of healthcare expenditures today, much bigger than people understand. And then where we have the opportunity to do blood draws, infusion, imaging, discharge planning, we can do those closer to the home or in the home [more] than we do today.”
One of the more amusing parts of the call was when the subject of Congressional efforts on tax reform was raised. Asked for his outlook, he acknowledged that it may have some impact but did not anticipate anything that would pull their feet up from under them.
“Our whole view is the best thing to do when you are going through Hell is just to keep going. We just keep plowing through it.”
Photo: Justin Sullivan, Getty Images
