CVS announced Monday that it plans to buy Signify Health, a network of more than 10,000 clinicians who provide in-person assessments and care to U.S. patients in their homes, along with virtual telehealth visits. The An $8 billion purchase is the main bet for the 59-year-old pharmacy chain. It is also an attempt to revive a relatively old concept: the doctor’s house call.
CVS is just one of several companies, including Amazon and Walgreens, that have recently invested in home health care. The reason why is simple: the number of people 65 and older in the US practically could double by 2060which means that the demand for medical care will almost definitely grow, also.
Completing the medical examination at home can be safer for people who face difficulties leaving the house. The return of the house call is also part of a broader transformation in how health care is delivered and, perhaps more importantly, who delivers it. Like CVS, many of the companies investing in home care are not traditional health care providers and are interested in using technology to take on much more than just home medical exams.
CVS, for its part, has made no secret of the fact that it wants to shift gears and become a technology-focused healthcare company (the chain officially changed his name in CVS Health in 2014). This plan includes closing about 1,000 of the nearly 10,000 US pharmacies over the next few years, while converting some of its remaining retail locations into clinics that they can provide urgent, primaryand mental health care along with traditional pharmacy services. The company already owns insurance company Aetna, prescription benefits management service Caremark and a nursing home-focused pharmacy service called Omnicare. Fresh launch virtual telehealth platform earlier this year, CVS is now adding doctors, nurses and physician assistants who also travel to people’s homes.
“The CVS concept? It’s a pretty brilliant umbrella that they’ve made,” explains Tara Cortes, Executive Director from the Hartford Institute for Geriatric Care at New York University. “They really have the whole package of providing a holistic approach to keep people at their highest health potential and safe in their own homes.”
House calls currently account for a relatively small proportion of physician appointments in the US. Doctors used to travel directly to patients’ homes—before automobiles, often via horseback—but primary care practices where patients traveled to became the dominant way people received health care during the 20th century. While house calls accounted for 40 percent of doctor-patient encounters in 1930, they accounted for only 10 percent of those encounters two decades later, and only 0.6 percent by 1980, according to New England Journal of Medicine study. Today, home health visits are mostly an option used by people with certain medical conditions, patients recovering from a hospital stay, and older people who benefit from in-home visits from clinicians. People who use these services often have Medicare Advantage plans, which allow people to include private insurance, including home care, as a supplement their Medicare plans.
Some think home inspections are necessary for a tech-adorned renaissance. The rise of telehealth, along with new connected devices—remote monitors, for example, can automatically update doctors on patients’ vital statistics—has made home exams possible. easier to facilitate. In general, sending a nurse or doctor to a patient’s home can be a more pleasant experience for the patient, and it also gives clinicians an insight into the patient’s daily life and practice. Some are speculated that the kind of data that Signify could potentially collectincluding information about what patients eat and their relationships at home could make healthcare delivery more efficient, although it is sure to raise real concerns about data privacy.
But like all things, there are real downsides. Some experts say the massive expansion of big pharmacies into many different aspects of health care could threaten the independent pharmacies that already exist. There are also broader antitrust issues. The FTC is already investigating Amazon’s acquisition plans primary health care network One Medicaland competition experts have warned that CVS could face similar obstacles to its plan to buy Signify Health.
“CVS seems intent on dominating all aspects of health care delivery with this acquisition, and home health visiting is part of that ambition,” explains Stacy Mitchell, co-director of the Institute for Local Reliance, a nonprofit that advocates for local solutions. “There are real concerns about the implications of that dominance in an industry that is already highly consolidated.”
However, CVS is not the only company involved in this effort. Amazon also bid to buy Signify, and its employer health care program Amazon Care offered an at-home appointment option before it was shut down earlier this year. Last week, Walgreens finalized a 330 million dollars an investment in CareCentrix, a platform that facilitates the care of patients at home after they have been discharged from hospitals. In 2020, the insurance company Humana bought a 100 million dollars stake in Get welltelemedicine and home health care service already available several countries. The company already owns home health care services provider Onehome.
Only time will tell if CVS’s proposal will pass regulatory scrutiny, and there’s no guarantee that the company’s foray into home health care will ultimately be popular with patients. However, it is already clear that the return of the house call is not really a return. Instead, it’s just one part of a new era of health care, in which traditional doctors’ offices and pharmacies aren’t the only players. It’s a “competition,” explains Cortes, “that the traditional health care system has never had.
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