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tv   Washington Journal Dr. Walid Gellad  CSPAN  December 10, 2017 2:38am-3:05am EST

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to get on the phone. what is different is that everything is amplified in terms of how far you reach and the speed of the communication. >> for the full schedule, go to tv.org.org -- book >> now, a discussion on the fromsed cvs-aetna merger "washington journal." this is 25 minutes. is the director of the center for pharmaceutical policy and prescribing at the university of pittsburgh. also an associate professor of medicine and health policy and he is here to help walk us through the impacts of the proposed merger between cvs and aetna. dr. gellad, thank you so much for joining us today. dr. gellad: good morning. host: so, tell us, i also want to note that cvs health changed its name three years ago. in some say to reposition itself
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as a health care company rather than a drugstore. talk about that. talk about the significance of a major drugstore chain merging with a health care insurance provider. dr. gellad: it is a must like this transition has been happening for decades. cvs started in the 1960's as a single store. kind of been expanding its footprint since that time. the minute clinics a decade ago, and then a joint with a pharmacy benefits manager to do other things and then it added some long-term care services, and some infusion services. it changed its name and got rid of tobacco. it really has been the evolution of the pharmacy. you set it. this is what makes it so unique atthat this happening pharmacy which is probably the first time this has happened in terms of integrating pharmacy more into the structure of health care. host: talk a bit more about wha is trying tok cvs
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achieve with this merger. dr. gellad: yeah, only they know, but you can, your imagination can fly in terms of what is possible for this. it can be incremental changes, it could be really what they talk about, which is really a fundamental transformation of how health care is delivered to understand you have to think a bout what cvs. for most people, it is the pharmacy around the corner but it also has a minute clinic and a pharmacy benefit management services and infusion services. you can imagine a fundamentally different way that health care is delivered, and i think that is what cvs talks about, and that is the goal. in fact, it's something pharmacists have been talking about for a long time, finding a way to put the pharmacy more the center of all health care is delivered. host: we are talking with dr. walid gellad about the proposed merger between cvs and aetna. we have regional lines.
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if you are in the eastern or central time zone, 202-748-8000. ion the mountain pacific regions -748-8001. cvs in its press release gave some insight into what they merger will do with some bullet points saying that it will combine cvs's health unmatched local presence and clinical capabilities with aetna health care's benefits, providing better integration of care -- and help them make more informed decisions. the transition expects to generate significant synergy for shareholders. and sort of, sort of putting this in the light of something that is really going to help its customers. is it really? dr. gellad: yeah. i mean, those are a lot of grand
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things they can happen, but it really, i mean, it really will, it can do all of those things they talk about. you can do none of those things. when you talk about cvs, which is present, there's 10,000 stores. the statistic i read was that 80% of americans live within 10 miles of a cvs and 70% live within three miles. cvs is just everywhere. and it is not hard to imagine the kinds of things they are talking about if you, for example, if you have an issue where you might call your pcp or try to go to the doctor's office if you can go around the corner and see someone, then it's just going to be a lot simpler. imagine taking it a step further, where not only do you go to cvs and see someone but there may be telehealth services and you can telehealth and see a specialist. there's all kinds of
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possibilities. remember, cvs is not just a pharmacy. it is home infusion services. think about instead of going to the doctor's office to get infusions of whatever medicine it might be, imagine if they do it at home. and they won't have to pay the facility anymore. they will not have to pay the doctor. it's these kinds of synergies that they talk about and when they talk about the opportunities for the consumer, they are talking about what happens when you can get these things done around the block or a few miles from your house for the same place you buy bread or milker sunglasses. that's the potential revolution. host: rudy on the line calling from chicago. you're on with dr. gellat. caller: merry christmas. this merger is nothing but the competitive battle of the -- walgreens and cvs. any other documented or unmet
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needs, there are several areas in america -- with lack of psychiatrists and thisedical specialties, merger does not talk about how they are going to generate that kind of professionalism within our medical schools, because any doctor knows at the university of illinois is the largest medical school in america. and also, the university of chicago is the largest public research center in america. this merger has no documented to address areas that are medically underserved in terms of public health issues. or dealing with the opiate -- in suburban or regional areas. outside a major city. along with a whole question of chicagog caerre, in cvs is new to the market.
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this is doing nothing to curb immunization, school physicals, the kinds of services you need to have -- the trauma, the kinds of services you need in a major metropolitan area. ast: i want to get dr. gellad chance to address that. a lot ofd: you named the problems with the current health care system. he is absolutely right. if i were cvs, i would say that, again, if you have a store within three miles or around the opportunityhave the to bring a lot of services to communities that did not have them using new technology. and i think that is a reality and that is the way the health-care care system is going in terms of telehealth services. in fact, other kinds of onnicians who can take more of the care. in some ways you can imagine this increasing access. maybe it will let hospitals focus on other things or expand and otherwise.
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totally right. in terms of the walgreens issue, i think that may be part of it. pharmacies are finding a way to compete and to become more central in health care system. as amazing has done h job spreading, they have taken over target pharmacies. who knows what's left? i totally agree there are a lot of problems with the health care system. this is a business vision but there are a lot of potentials to expand access for people, given these stores to where people live. host: we're joined by dr. gellad, the professor of health management at the university of pittsburgh. he's helping us break down the proposed merger between cvs and aetna. a question that i have that i'm sure some of my viewers might this too, is how does impact consumers immediately or down the road? the closest a cvs,
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pharmacy to me, but i am not an aetnaw customer. will my drug costs be higher? dr. gellad: those of the questions everybody's asking and there are no answers. it depends how things are implemented kid we have already seems limitations and what pharmacies you can go to. and this is what's happened in the market. aetna already uses cvs as his pharmacy benefits manager and most people with aetna probably have a preference to go to cvs anyway. the concern is obviously that this will become more of an issue for consumers. and there are other ways that consumers can be steered towards certain pharmacies rather than others. so, you could easily imagine and this happened at much higher cost. if you go to another pharmacy, you can imagine much higher cost of you go to a different urgent care center than the urgent care centers in cvs. it's going to be variable
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depending on what consumers need from cvs. theperson just walking into pharmacy may not notice any difference, but it will. anytime you have consolidation like this and integration, there is always the concern that it will decrease the choices available to consumers. the flipe flip side, side argument is that this is going to help us manage costs, reduce costs for employees. rs. make premiums less, which provides benefits for consumers. but it is a trade-off between costs and the ability to go anywhere you want. host: we talked a lot about the motivation of cvs, perhaps other drugstores. what about on aetna's side? what is the motivation of health insurance providers in partnering and merging with drugstores? dr. gellad: yeah, and that is an
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excellent question. aetna tried to merge previously in it did not go through. this is a slightly different merger. but there is, there is a trend in health care of trying to integrate payers and providers. it is happening all over the place. you saw united health care doing the same thing with buying providers. ultimately, the issues that insurers have is that things are really expensive. they're trying to make money and anything they can do to lower the price of services that they have to pay for, they will make more money. one of the best ways to lower the price is to really be able to do things in a setting that is less expensive. and so, you can imagine a lot of things that currently happen, in a hospital or the doctor's office that can be less expensive done in other settings. this arrangement really will facilitate that. aetna could make deals with cvs, but when they are under the same
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parent, the presumption is that there will be less berries to do that. they can do pilot programs. they can see how this works. if it does work, you can imagine the kinds of customers they would get. aetna has a lot of business in medicare and medicaid. if they're able to really improve satisfaction and lower cost whatever it might be, that is an opportunity to really grow their business. host: bill's on the line from georgia. good morning. caller: i'd just like to say that i disagree with everything dr. gellad said. number one, in markets where not not, where there's enough money, especially rural meidicine, there have been more physicians. must the fact that the physician is a professional and provides a service and his name, customers his patients. for cvs-aetna, the patient is no longer -- there's no professionalism there.
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the -- the patients would be forced to use aetna products. and a may not be the best products for that patient. we lose the bond between physicians and patients. and, you know, i have one question for dr. gellad. i know he's not really thought about that issue about rural medicine. is he a paid consultant with any pharmaceutical companies? i'd appreciate hearing the answer. guest: no, i'm not a consultant for any pharmaceutical company or any pharmacy or any company. but i appreciate that question. that is an excellent question. i'm a doctor. i completely get what you are saying. there is a special bond and a special relationship and this does have the potential to disrupt that. i don't want to minimize that or minimize that at all. and, um, in, so, let me get to
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that and then it will get to the issue about rural areas. a trend,e's been because you brought up a lot of issues. there has been a trend about services leaving the primary care provider's office nad practice -- and practice. and all of these things disrupt the relationship, and we have seen the minute clinics in the retail clinics, which disrupts care a little bit, all the specialization of care. and it is a challenge. but on the other hand, we have a market. and this is the way the market is going. it can be tough for patients but themately -- if it is not most cost-effective way to seek care and that is what is going to happen in the market we have. any, you brought the issue about who is the customer? i mean, you are absolutely right large,ese are two for-profit companies. and the big concern is that, lik
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e any for-profit company, we might see shareholder value prioritize, in the short-term, over patients. that can happen and you do not one of minimize that. that would be a problem for patients. ultimately it is a balance between having a market we have thetrying to keep doctor-patient relationship and the patient-provide relationship. another point you brought up, let me make two more quick points about this issue of professionalism. i think pharmacists would argue vehemently maybe contrary to what you said in terms of professionalism that might be present in the pharmacy. they really view their relationship with patience and a professional light and they have been pushing for more of a role in the care of patients, and they do it very -- view it very seriously. i think the reality is all of this is happening, and as a
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doctor, i think about this all the time, and the reality is what can doctors do to provide the best service and demonstrate their value in this new marketplace? the last thing about rural care , hospitals are closing in rural areas. maybe this is a way to access care. the issues around telehealth and the expansion of access through technology is one way to address the rural health problem. host: we are talking to dr. walid gellad, at the university pittsburgh about the proposed .etna-cvs centraltimern or zone stash -- ruth from georgia. good morning. either question i would like to address about the medication you received from cvs. when you have to do the mail-order care.
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the medicine that you reallym has hurt bad. legs have swollen until the skin breaks, my feet hurt all over and now i have a harder time because the medicine that my doctor sent in to them, they get it from india or someplace else. and i have a terrible reaction to it. how do you address things like that if that is the only place get yourcan go medicine and not have to pay full price for it? dr. gellad: yeah, i think that is an excellent question. i think the argument, first of all, i think you should talk to your doctor about all of these things. but the argument, i guess, to make that cvs would make is that
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if you have all of these issues, you can come into the pharmacy and talk to the pharmacist. pharmacist you would have more of a regular interaction with and that may help you address some of these concerns with that medicine. i do not think this is going to change dramatically all the issues you talk about in terms of where the medicines come from, how they deliver, but the argument is that when you're having problems with medicine, you can go around the corner and go back to cvs to discuss this with a pharmacist or someone who can help you address these things. can you talk about what this might portend for the future? amazon is exploring selling medicine. might we see more of this kind of cross-section or combination of different industries sort of getting into the medical delivery business? dr. gellad: yeah.
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and everybody has speculated on that. that is a quite question. -- great question. some people say this is about amazon and some people say this is nothing about amazon, a progression of what cvs has don e. my own opinion is the pharmacy is the place where medicines are dispensed has been dying for years. you know, there is mail-order and mail-order pharmacies. there other ways to deliver medicines. you are no longer get it, maybe you're getting longer supplies. pharmacies have been trying to tod ways, again, to incorporate themselves more centrally into health care. think if amazon goes on to deliver prescriptions, this is yet dispensing that the medicine part of the brick-and-mortar pharmacy will become less important, but yet the pharmacy's location and cvs is a mail order pharmacy will become more important. in fact, you saw cvs, i can't
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remember how long, fume i promised to have same-day delivery, a response to amazon. i think if amazon were to come into the market, it will compete on mail order discussions-- mail order prescriptions cvs, and it is something it will compete with cvs, but cvs-aetna would be a payor and be a location where care is delivered, which would give them a competitive edge they would argue against just having a mail order place like amazon. host: steve's on the line from henderson, nevada. good morning. caller: good morning. host:= go ahead. 've used the minute clinics before and they do take a number of insurance groups, but i was concerned in whether having aetna tied with cvs, would that create a conflict of interest?
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i'm goingh, i guess to avoid any specific legal arguments. i am not a lawyer, but will will happen, ithat will will be an issue for other insurers if aetna and cvs are merged, that other insurance will not want you to go to cvs minute clinics and will contract with other retail clinics. med-express, some which are owned by united. in the same way we are seeing payers and providers -- merge. if you are payor, you do not want your patience you are taking care of go to a facility owned by another provider, it is probably the same thing with these urgent care clinics. if you have aetna, they would most likely ready you go to some otheric than retail clinic and they will do that by not paying for other places you go to, or they will
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make you pay more if you go to other places or pay less if you go to minute clinics. wouldat is, i think that be a natural progression of what would happen here. whether it would be a conflict of interest or whether there were any legal issues, i do not really know. host: james is calling from fort myers, florida. caller: good morning. hello? host: go ahead, james. about: i am going to talk my personal relationship. i travel a lot to costa rica and the role that the pharmacist plays in costa rica is more like the cvs-aetna kind of merger. you can actually go to the pharmacist instead of the doctor and get medicines or get diagnosed by pharmacist, within -- because they actually are a doctor anyway. and you can get, actually diagnosed by a doctor. a pharmacist and you
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need to see a doctor, he'll forward you onto that but there are certain things that he can do as a pharmacist, that hecan prescribed for you and he can give you certain medicines right take care of that instead of having two separate occasions where you go to the doctor and the doctor prescribes medicine and then you go to the pharmacist. in costa rica, they kind of do it a little bit like what aetn'' s trying to set up with cvs where the dr. plays a different role for more cases that are mo intensive, where the pharmacist plays another role and dispenses medicine and advice to the patient. dr. gellad: yeah. i think you have just described hee pharmacist's dream in t united states. this is what pharmacist would like in the argument is what you say it is -- people do not have to go see the doctor. and it will be less expensive.
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is,what you are describing i think, what cvs would like. and the various to that have been issues around who is a provider in the united states, who gets paid as a provider and how that payments works. you can imagine if the payer also owns the pharmacy, they can set a pilot programs and arrange these cause of things. there are pharmacist are integrating themselves in the care and doing more prescribing. a primary care doctor, i have mixed feelings. there is no doubt in terms of convenience and for certain conditions, there is huge potential advantage. and i think you can read the cvs promotional material as pie-in-the-sky, just kind of talk, or you can view it as what they really view the future's spirit i think it is the latter. i really think that this is what
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they are pushing for and this is what they believe can happen, and this is one way to make it happen. i appreciate your sharing your experience. that is a great point. host: radndy, you only have a couple of seconds. can you make it quick? caller: good morning, dr.. -- doctor. with all due respect, america's alth lies in the hands of schools. if we do not teach american children how to prevent their own self-inflicted wounds, diabetes or other chronic nesses, if we keep sitting on our rear ends, we will not solve any problems. host: a couple seconds to address that quickly. dr. gellad: i agrees that the causes of all of these problems started a long time ago and they started outside the health care system.
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>> i think you are totally right about fixing problems before they start. find the website. you can find him on twitter. thanks for joining ♪ >> c-span's washington journal, live every day, with news and policy issues that impact you. coming up this morning, look at immigration enforcement. shownment statistics that fewer arrests on the u.s.-mexico border. is a greatbatch migration policy institute member. of tuesday'sw alabama senate race to with an editor. be sure to watch c-span's washington journal live at 7:00 eastern this morning. join the discussion.

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