How digital health fits into CVS, Aetna's past actions - and future plans

By Jonah Comstock
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CVS Health made a surprising announcement yesterday: It has reached a deal to acquire health insurer Aetna for $69 billion. While a pharmacy chain buying a health insurer seems strange on the surface, from the perspective of the consumerization of healthcare it makes sense, and the two companies said as much in their official announcement.

"This is the next step in our journey, positioning the combined company to dramatically further empower consumers. Together with CVS Health, we will better understand our members' health goals, guide them through the health care system and help them achieve their best health," Aetna CEO Mark Bertolini said in a statement. "Aetna has a proud tradition of continually innovating to address unmet consumer needs and providing leading products and services to the marketplace."

By combining the data and data analytics capabilities of the two companies, the companies hope to reduce hospital re-admissions and improve treatment for patients with chronic conditions.

"Patients with diabetes will receive care in between doctor visits through face-to-face counseling at a store-based health hub and remote monitoring of key indicators such as blood glucose levels," CVS explained in a statement. "When needed, patients can receive text messages to let them know when their glucose levels deviate from normal ranges. As a follow up, patients can receive counseling on medication adherence, pick up diabetes-related supplies and engage ancillary services such as counsel on weight loss and programs designed to reverse diabetes through nutrition. This will result in better control of their blood sugar levels and better health, which should be appreciated by both patients and their doctors."

This is similar to work Aetna at least has been doing for a while now. At HIMSS in 2014, Bertolini talked about some initiatives the company has underway to monitor patients with chronic disease and intervene before it becomes costly and life-threatening. The payer was partnering with Medtronic to use the data feed from pacemakers to figure out when a cardiac patient has put on extra water weight and is in increased danger of congestive heart failure. They were also working on a pilot with continuous glucose monitors to try to predict and prevent hypoglycemic events.

"These types of interventions are things that the traditional health care system could be doing," he said in a statement, "but the traditional health care system lacks the key elements of convenience and coordination that help to engage consumers in their health. That's what the combination of CVS Health and Aetna will deliver."

CVS and Aetna have both been in the digital health space for a number of years.

CVS launched its first mobile app in 2010, for iPhones only, over half a year after they launched a new mobile website. CVS members could use the iPhone app to fill a prescription, check a prescription order status, view the prescription history, check the cost of the medication, and locate a nearby pharmacy. At the end of 2011, CVS added Android support.

In 2013, CVS announced that it would be working with NantWorks-owned Vitality, which sells GlowCaps, cellular-connected caps designed to help people remember to take their pills. The companies announced that they would work together in a randomized control trial using GlowCaps to test the effectiveness of sweepstakes to improve medication adherence.

Shortly afterwards, the company launched a new CVS iPad app, a virtual pharmacy that presents the user with a 3D virtual pharmacy, where each section of the store corresponds to a functionality for the app. In July 2014, CVS added a drug interaction checker to its CVS Mobile app that cautions consumers when an over-the-counter medication might interact with other drugs they are taking. The company claimed to be the first drugstore chain to include such a feature in a mobile app. The company launched a Digital Innovation Lab in Boston that same year.

In 2015, CVS forged partnerships with three of the leading telemedicine companies, Doctor on Demand, American Well, and Teladoc, piloting the telehealth services in half a dozen states and leveraging different telehealth companies in different regions of the country. CVS also updated its Minute Clinic app to include wait times and remote scheduling

Aetna's biggest digital health footprint, on the other hand, is its iTriage app, which the company acquired in 2011. iTriage has evolved from just a symptom navigator, physician and hospital finder app to include price transparency tools, health education and literacy tools, prescription management tools, and -- soon -- maybe even video visits with physicians. And other Aetna apps do even more: Aetna Mobile has many of iTriage's features, plus it allows Aetna members to access information about their insurance, and Aetna's Resources for Living app helps users to manage stress and anxiety, moderate work-life balance, and track their moods. 

Some of Aetna's forays into digital health have been unsuccessful. The company launched a data aggregation and wellness platform called CarePass in 2012, but ended up shuttering the venture in 2014. A caregiver app called InvolveCare suffered a similar fate.

As well as the chronic disease management pilots discussed above, Aetna has also invested in employee health, as with a remote patient monitoring and patient engagement pilot with Newtopia in 2015. The platform uses genetic testing and lifestyle assessments to create personalized nutrition, exercise and behavior management plans for users. Newtopia then supports users with online coaching via mobile devices, social networks, and wearable device integration.