Corporate Moves in Healthcare Continue to Disrupt the Industry

By Health Capital Consultants LLC

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Instead of waiting on regulatory reform, corporate America has sought to disrupt the healthcare industry over the last few years, by streamlining the delivery of healthcare (and associated costs) and taking advantage of technological advancements.

CITE: https://www.r2library.com/Resource/Title/0826102549

This entrepreneurial approach to problem-solving may provide meaningful competition to traditional healthcare organizations, which may result in higher quality, more affordable healthcare. Some of the biggest companies in the U.S. – CVS Health, Walgreens, Amazon, Walmart, and Best Buy – are expanding their healthcare empires through acquisitions and other strategic moves. (Read more…) 

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VALUE BASED CARE: CVS and Walgreens

The retail pharmacy giants have made a string of multi-billion dollar deals!

By Staff Reporters

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CVS and Walgreens have been spending money like there is no tomorrow! In fact, the two retail pharmacy giants have made a string of multi-billion dollar acquisitions of primary care providers in the past couple years, including the $5.2 billion VillageMD acquisition in 2021 (Walgreens) and the $10.6 billion plan to buy Oak Street Health (CVS).

VillageMD also bought primary care clinic operator Summit Health-CityMD in January 2023, which Walgreens invested $3.5 billion in, and CVS spent roughly $8 billion to acquire Signify Health, a value-based payment platform, in September 2022.

So what do all these deals have in common? Value-based care.

CITE: https://www.r2library.com/Resource/Title/082610254

READ Healthcare Brew: https://www.healthcare-brew.com/stories/2023/03/03/cvs-walgreens-value-based-care?cid=30723705.29836&mid=349b552221c994e2540a304649746d7c&utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew

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CVS, Walgreens and Walmart: Opioid Settlement

By Staff Reporters

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CVS, Walgreens, and Walmart agree to pay $13 billion over opioids

The pharmacy chains have reached a tentative deal to settle thousands of lawsuits brought by state and local governments that accuse them of contributing to the opioid epidemic.

If the deal goes through, CVS and Walgreens will each cough up around $5 billion, and Walmart will reportedly be on the hook for $3 billion.

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PODCASTS: How Prescription [Rx] Coverage Works

Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

By Dr. Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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Economic Market Update

END OF “WHAT A WEEK”

By Staff Reporters

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Wall Street closed lower on Thursday as investors banked some profits after three straight days of gains and turned their focus toward upcoming inflation data and how it might influence the Federal Reserve’s meeting next week.

So, what about today-prognostications?

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Pharmaceutical Stocks in the Post-Trump Era?

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By Vitaliy Katsenelson CFA

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Trumps Hates Them – We Love Them

 Originally written for Institutional Investor Magazine
 A few weeks after Donald Trump was elected president of the United States, he was asked about pharmaceuticals prices. With typical rhetorical gusto, he declared, “Pharmaceutical companies are getting away with murder.” Well, my firm has been increasing our allocation to those “murderers,” and despite Mr. Trump’s comments, we are very comfortable with our positions in the long run (which lies beyond what may end up being a very volatile short run).

Big Pharma

Pharmaceuticals companies check off a lot of boxes in our quality and growth dimensions. They are usually monopolies or oligopolies when it comes to their specific drugs; they have high recurrence of revenue; their business is not cyclic and thus marches to its own drummer; they have strong balance sheets and a high return on capital, and generate a lot of cash flow; they benefit from a significant growth tailwind as the global population ages (I aged just while writing this); and they enjoy pricing power (more on that later). Yet the pharmaceuticals sector as a whole has been decimated over the past eight months due to perceived political risk — first by pharma pricing critic Hillary Clinton’s “It’s in the bag” expectation of victory and then by Trump’s “They get away with murder” comments. We view the carnage created by the political risk as an opportunity to increase our exposure to this sector. Here is why.

President Trump mentioned that he wants the U.S. government — mainly, its Medicare program — to negotiate directly with drug-makers on price. His remark may create the impression that pharmaceuticals companies today charge the government whatever prices they want. That is not the case. Medicare covers prescription drug costs through a program known as Medicare Part D. Medicare basically outsources the negotiation of drug prices to pharmacy benefit management (PBM) companies such as CVS, Express Scripts, and UnitedHealth Group (a health insurance company that owns its own PBM). In fact, less than a handful of PBMs control this market and so exercise tremendous pricing power; thus the government is already negotiating with pharmaceuticals companies.

The Stats

Here are some useful stats about this market: As of the end of 2015, 290 million Americans had health insurance. Among them, 214 million had private insurance and 52 million were insured by Medicare. Medicare insures a lot of people; however, UnitedHealth — a company whose business model relies on paying as little as possible for prescriptions — insures 70 million Americans and thus already has greater bargaining power than Medicare.

But let’s say President Trump gets his wish, the law is changed, and the government bypasses PBMs and starts bargaining with Gilead Sciences, Amgen, and Allergan directly — the Trump take-no-prisoners approach. Let’s even assume that President Trump’s ingenious negotiating techniques result in a 20 percent concession on price. Since Medicare represents only 18 percent of the total insured population, the net impact on pharmaceuticals companies’ revenue would be 3.6 percent. That’s a small pimple that they’d be able to cover up by raising prices 4 percent on the remaining 82 percent of payers.

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Europeans and Canadians

The reality is that the reason Europeans and Canadians are paying much lower prices for their prescriptions is that they have a single-payer system, and thus pharmaceuticals companies are bargaining not with four or five entities but with one: the government. At this stage, however, it is very unlikely that a Republican president and Republican-controlled Congress will move this country to a single-payer system.

If the U.S. starts allowing re-importation of pharmaceuticals from Canada and Europe — another threat made by our president — then American companies will simply start raising prices outside of the United States.

Finally, let’s remember an important but often forgotten fact: Donald Trump is the president of the U.S.; he is not its king and doesn’t have the powers of one. Although we expect his tweets and other remarks to create additional volatility, they will not necessarily have a symmetrical impact on pharmaceuticals companies or whatever other businesses he tweets about.

Assessment

We have taken advantage of price weakness and added to our positions in Amgen (analysis here), Allergan (analysis here), and Gilead (analysis here). We also bought some new positions. Stay tuned for next week, when I’ll reveal those names.

Conclusion

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Retail Medical Clinics and IT

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Competitive HIT Issues Emerging by Default

[By Dr. David Edward Marcinko; MBA CMP™]

Publisher-in-Chief

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Health entities of the Physician Practice Management Corporation [PPMC] era might be termed the originators of corporate medicine despite contentious legal policies and prohibitions. Since then, there have been other modifications to the business model, as those PPMCs left for dead by the year 1999 made a modest comeback thru 2003-04.

They did so by evolving from first generation multi-specialty national concerns, to second generation regional single specialty groups, to third generation regional concerns, and finally to fourth generation Internet enabled service companies, providing both business-to-business [B2B] solutions to affiliated medical practices, as well as business-to-consumer [B2C] health solutions to plan members.  

Prior machinations were ambulatory surgery centers [ASCs] and out-patient treatment centers [OPTCs], while the newer twists are specialty owned hospitals.

Social Transformation of Medicine 

And so, I believe that Paul Starr, author of the Pulitzer-prize-winning book “The Social Transformation of American Medicine” who first predicted healthcare corporatization was more correct, than not.

But, his vision was early in the evolutionary game. And, while corporate medicine seems inevitable in 2008 and beyond, the marketplace is still struggling for the correct business mode. It needs something that bridges the gap between medical professionalism and ROI.

The Balancing Act 

In-other-words, a better balancing act is needed. Slowly, like capitalism itself, the pendulum will swing back and forth between paucity and excess, until a point is reached where all concerned are moderately satisfied, ethical, and marginally profitable; while delivering quality medical care that is more needed by the citizenry-many [i.e., more pediatricians, internists, primary care doctors, OB-GYNs, nurse-practitioners, PAs, etc]; than the vital-few [neuro-surgeons, pediatric endocrinologists, super specialists, etc].

Maybe this “missing balance link” is the retail medical clinic model.

Retail Clinics 

As most doctors, payers, patients and consumers are aware, the retail quick-service medical care concept has found a familiar place in national chains such as Target, Wal-Mart and CVS, where pharmacies and patients already exist, and space is inexpensive and abundant.

These clinics are typically staffed by nurse practitioners and offer a limited menu of walk-in medical services with insurance co-payments between $10 and $30. And, unlike some physician practices, private pay patients are welcomed with fees ranging from $55 to $85 cash in many parts of the country!  Prescription drugs are nearby at robust generic discounts, or even for free in some cases. Office hours are extended, and convenience reigns.

HIT Issues by Default? 

Ironically, as one positive side-effect of this innovative next-gen corporate practice model, may be the goading of late adopting, tight-fisted and/or refusing MD-niks to enter into the modern health-information-technology [HIT] age.

Thus, one way to get margin compressed private medical practices up and running with electronic medical records [EMRs] may be these same retail clinics.

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Projected Growth of the Retail Industry 

Today, more than 800 retail clinics are open for business, and analysts predict that 85 percent of the U.S. population will have a clinic within five miles of home in five years. And, the number of retail health clinics is expected to multiply in 2009; as recently reported by the Washington Times

Illustration

Now, ponder the current state of affairs where a retail clinic [say Walgreen’s, etc] treats a vacationing patient for $65; who then receives the medical-record instantly on a flash-drive or securely uploaded to some virtual storage facility?

Just how will that patient’s premium priced private practitioner back-home explain his/her lack of EMR technology, and ages-old anchor to the hand-written paper-based medical records of yore?

Can you say Dossia.org, HealthVault.com, etc?

Competitive Assessment 

The ideological leap from technical buffoonery – to clinical distrust – will not be great in the minds of the modern, intelligent, educated and insightful patients that we all crave.

Assessment

Of course, one wonders how long will it take for EMRs to become a strategic competitive advantage for early adopting physicians. Will late adopters even survive as EMTs become main-stream?    

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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