George Van Antwerp, who blogs at Enabling Health Decisions, posted a thoughtful rebuttal to When will CVS and Caremark split up?In CVS Caremark Split Up?, George answers my three questions about CVS Caremark but comes to very different conclusions. Check it out.
Here's my re-rebuttal:
- In theory, theory and practice are the same.
- In practice, they are different.
Poll Question: Will CVS Caremark split up?P.S. Please check out the latest Health Wonk Review hosted by Hank Stern at InsureBlog.
Regarding the exciting idea that CVS and POS RPh's can be successful in disease management, let's verify that the theory has precedent by producing pilot data of some form. What I would want to know is what percent of patients do pharmacists actually counsel to better manage their diabetes as measured by improved adherence, reduced HgbA1C, and overall lower ER visits and hospitalization rates? How many pharmacists know about all the basic tenets of the psych-social issues related to getting a person with diabetes engaged in their health so THEY can better manage their lifestyle? I've seen a lot of excitement come like fireworks over that past 20 years only to come see it fade like burnt out cinders as they hit the ground. I would first ask the question? Are all the people that are going to be involved capable of delivering results as having proven they have done so in the past?
ReplyDeleteI believe that the core case study which is used is the Ashville project (http://www.centervbhm.com/bp/diabetesashevilleproject.html) which demonstrated the use of pharmacists in managing diabetes outcomes.
ReplyDeleteYou're right that the percentage of time that pharmacists spend on cognitive services is too little (like MDs). The question is whether that can be fixed. I believe things like pharmacy kiosks can help with this to free pharmacists time up.
There is also the issue of space for consultation and reimbursement.
I do think that a lot of chains like Walgreens and CVS have trained the pharmacists on motivational interviewing and other consultative techniques. There are also some pharmacists that really know some conditions like diabetes very well.
I also think that the Medco Therapeutic Resource Centers have demonstrated success using pharmacists who focus on a specific disease state. I expect that their Drug Trend Report due out next week will have some good case studies on this.
I left the retail setting years ago because of the lack of clinical opportunity in that setting. I don't see a big difference today. Retail is still measured by Rx volume and store profitability -- not clinical effectiveness.
ReplyDeleteThese companies have shareholders. The decision largely depends on the asset value of Caremark inside CVS compared to its standalone valuation. Wall Street will demand the spinoff unless the asset can be properly and synergistically valued. ESRX has a market cap of $28B and MHS $26B compared to CVS/CM of $49B. Are the two chief assets properly valued?
In my experience PBM and Retail objectives tend to be diametrically opposed vs synergistic. This means one asset will suffer under the dominion of the other.