December 21, 2018
5 TO WATCH IN 2019

Lynch takes Aetna's reins amid quest to reshape healthcare landscape

Aetna President Karen Lynch

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During a bike accident in the Netherlands this past summer, Karen Lynch broke her hip and hands and injured her ribs. She was forced to fly back to the states where she had surgery and received care at Massachusetts General Hospital in Boston.

The incident taught Lynch, president of Hartford health insurer Aetna and executive vice president of CVS Health, two major lessons.

First, it reaffirmed the importance of good health and staying in shape. She and her doctors credit a quick recovery — in an early November interview the slim and fit Lynch had no apparent signs of injury, though she said she hadn't resumed running yet and still had trouble tying her shoes — to her good health prior to the accident.

The ordeal also reaffirmed what she already knew about the healthcare system — that it's complicated to navigate and not always well coordinated.

Ironically, Lynch is on the frontlines trying to fix that.

In November, she took over as the top executive of Aetna, following the health insurer's $69 billion tie-up with Rhode Island-based CVS Health.

The deal is one of the largest healthcare combinations in U.S. history, and in many ways it has promised to reshape the healthcare landscape by pairing a large drug store/pharmacy-benefit manager with the third-largest U.S. health insurer.

How that pledge plays out will begin to be seen in 2019.

"There's an opportunity for us, and we know this because this is part of our strategy, to connect all the pieces of our healthcare system," Lynch said.

Aetna will continue to exist as a standalone entity and keep its brand, but it's now part of a corporate behemoth with more than 300,000 employees. In the near term, Aetna won't have major operational changes. Its headquarters will remain in Hartford for at least the next 10 years and CVS has promised to maintain 5,291 employees here for at least the next four years.

Meantime, the company's mandate, Lynch said, includes being local, simplifying the healthcare process, driving consumer engagement and improving customer health, and she views the partnership with CVS as a way to better deliver on those priorities.

In particular, Aetna will now have the opportunity to leverage CVS' retail clinics, which she said will become a new front door to healthcare services, where programs are rolled out across the country that aim to reduce avoidable hospital visits, and help patients better manage five complex chronic conditions — diabetes, cardiovascular disease, hypertension, asthma and behavioral health.

CVS and Aetna say all of those efforts should help lower medical costs, which is one of the biggest business arguments that was made for the deal.

In early 2019, the companies will roll out new concept stores in select locations around the country (but not in Connecticut).

CVS' Minute Clinics will start to look more like health offices. Pharmacists will play more of a consulting role and better connect with customers' primary care doctors. Stores will also begin to employ more nurse practitioners.

Enhanced community services will include nutritional and behavioral counseling and benefit navigation support, as well as assistance with digital health apps, connected devices and durable medical equipment, including remote-monitoring devices that will be used more commonly.

CVS store footprints could also change to better promote healthy living. For example, candy bars could be pushed toward the back of the store, while more healthy snacks move toward the front. (They want customers to choose a Kind bar over a Reese's Peanut Butter Cup.)

Lynch insists they aren't trying to replace primary care doctors, but instead offer another convenient, low-cost access point for patients, many of whom don't have regular physicians in the first place.

"If you have high blood pressure, instead of going to the doctor, you go to CVS and check in with a nurse case manager that Aetna has in the store, or you talk to a pharmacist," Lynch said.

The companies will also integrate their medical data for improved analytics.

Market disruption

Fred McKinney, the Carlton Highsmith Chair for Innovation and Entrepreneurship at Quinnipiac University's School of Business, said the biggest benefit for CVS in the deal is it will now have the opportunity to solidify relationships with Aetna's 23 million customers, many of whom are part of large employers.

The deal also provides Aetna some security in a very insecure market. He thinks the health insurance industry is in for long-term challenges, including one day facing the possibility of the country adopting a single-payer system.

Meantime, there is also pressure from tech companies like Amazon getting into the pharmacy business.

"Most companies in both health insurance and the drug and pharmacy space are looking at the future," McKinney said.

One of the biggest short-term challenges McKinney sees for Aetna and CVS is combining two different corporate cultures.

Lynch said the two companies' strategies and cultures are very similar and she doesn't see any big problems meshing them together, but they will need to find a promised $750 million in savings as part of the combination.

The biggest focus in 2019 will be getting concept stores up and running and starting to talk about new products and services.

"The biggest challenge is going fast enough," Lynch said.

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