Integrating US Health Insurance And Healthcare

As health insurers and healthcare integrates in the US, customers are being guided as to where to get treatment.

CVS Health is trialling a coordinated care pilot for knee replacements for Aetna insurance customers.

In the pilot, pre- and post-operative care for Aetna MA and commercial members undergoing a knee replacement procedure will be managed by a clinical team in the home, at CVS pharmacy locations and via telehealth. Wherever the knee replacement pilot will run, CVS will look for opportunities to expand to other conditions and procedures.

The trial is the first in a series of initiatives CVS and Aetna are working on, and will be available for as many patients as possible. The model aims to cut costs by reducing hospital readmissions, amid a broader push in the USA to move care away from hospitals.

The volume of total joint replacements in the USA, including knee and hip replacements, has risen continuously over the past few decades, as the population grows older.

According to the Agency for Healthcare Research and Quality, 600,000 knee replacements are performed each year in the USA. The American Academy of Orthopaedic Surgeons predicts that by 2030, total knee replacement will grow by up to 189%, and 90% of people who receive one report less pain from chronic conditions such as arthritis.

The company has been expanding its CVS HealthHUBs, retail locations that devote 20% of their floor space to health services with a focus on preventive care and wellness. CVS plans to open 1,500 HealthHUBs by the end of 2021 as part of its enterprise growth strategy, and has already seen increased traffic and higher margins in the locations compared to regular CVS stores.