How the CVS-Aetna merger will change healthcare
Foreshadowing change with an achievable fiction.
In a recent interview, the CEO of Aetna, Mark Bertolini, asked this question: “What would you have to do to reimagine the experience so that you became the front door for the healthcare system?” Days later, Aetna announced its intent to be acquired by CVS, in a deal that will likely change the face of the healthcare industry. We’ve picked up his challenge and visualized the possible future this merger could bring—one where the trends of delivery reform and shared control with patients results in a personalized health service focused on one of the biggest challenges in healthcare, maintaining wellness rather than simply treating disease.
20th century medical science has helped to extend our lives and turned the healthcare tide from the traditional model of acute intervention to a new model optimized for chronic disease prevention and maintenance. A population that lives longer means an uptick in chronic conditions that insurers have to account for and manage. To engage with an aging American population, it will be critical to pay close attention to the quality of the healthcare user experience. It’s not hyperbole to say our lives depend on it.
We need to find new and better ways to deliver care and maintain wellness to meet the needs of changing demographics. No one knows this better than healthcare industry leaders, but they (and we) are stuck in a difficult-to-change healthcare system. As designers working in complex systems, it is important for us to challenge the assumptions that maintain the status quo. Grounded futures—a design fiction approach built on a real-world context—push us beyond individual products and services toward systemic solutions that will make a real difference. Rather than making implausible predictions, a systematic approach helps us create an achievable fiction.
A new beginning: Horizon, by CVS-Aetna
Our story begins in a future where the CVS-Aetna deal has heralded an industry shift toward vertically-integrated consumer-centric healthcare organizations. Barring political opposition, value-based payment—aligning provider payment with outcomes rather than procedures—is now the norm. Health systems now actively seek ways to improve the wellbeing of an aging, but healthy American population. In a value-based landscape, financial incentives for insurers and hospitals are aligned. Hospitals become more profitable when their constituencies are healthier and insurers spend less to help patients maintain their health and efficiently manage the onset of chronic disease. Both payer and provider have agreed that a focus on population health, preventative care, and wellness services can be a successful way to achieve these shared goals.
Enter Horizon, the Wellness Network, by CVS-Aetna. A partnership that brings individualized wellness services, preventative care, and medical expertise to the patient’s doorstep. In this near future, accessing a coordinated suite of digital therapeutics, lifestyle interventions, and clinical advice is as easy as going to your neighborhood pharmacy. Horizon is built on reimagined services from the three pillars of healthcare user experience:
How Horizon works: Three innovations
Individualized health plans and digital therapeutics
In this new healthcare environment, CVS-Aetna’s focus on big data-driven analytics enables the company to offer individualized plans with services optimized for the individual patient. Patients can opt for a $14.99 monthly subscription model—not unlike other popular internet services—which provides access to AI-enhanced resources like real-time digital therapeutics, telemedicine consultations, and wellness coaching to help set and achieve health goals. When the patient sticks to their plan, at the end of the year they get that money back as a health dividend.
Individualized coaching covers all aspects of a patient’s lifestyle—from nutrition to medication, treatment to exercise. This extreme personalization enables patients living with chronic disease to access products and services optimized for their complex situation, bringing preventative care and real-time advice into their everyday lives.
More than a pharmacy: a Wellness Hub
The social-hub of the old-fashioned pharmacy soda fountain and lunch counter is reimagined as a community-based site of care. CVS-Aetna’s customer-centered pharmacy and medical clinic expertise brings Horizon’s wellness services right to a patient’s doorstep by adding “medical fitness” facilities into their nation-wide retail footprint. Unlike traditional gyms, certified centers support people of all ability levels, making them attractive even to the healthy, but aging baby boomer cohort. Building on the CVS Minute Clinic, expanded in-person services include nutritionists, trainers, and rotating specialists.
Preventative medical expertise available as needed
In order to deliver on the value-based care model, health systems partner with Horizon to extend the reach of their medical expertise outside the hospital walls. Specialists and educators rotate through real (and virtual) appointments at a number of Wellness Hubs, working with engaged patients who seek assistance with lifestyle change or chronic disease. Best of all, they operate outside the traditional “sick care” model, reducing the expense required to bring preventative services to their patient populations, while also reducing costly but avoidable interventions, admissions, and readmissions.
Beyond general health and fitness, Horizon offers a comprehensive approach to disease management that’s integrated directly into local communities. Targeted disease-specific products and services help patients manage the lifestyle change necessary to delay or manage the onset of complex chronic conditions like diabetes, heart disease, or arthritis. As healthcare analyst Ana Gupte says, of the retail-location based CVS-Aetna model, “If they can drive the adoption of the care delivery model, that’s a big deal.”
The bigger picture
A grounded futures approach makes it easier to get beyond our assumptions of how things work and imagine innovative new products and services we and our clients couldn’t see before. In industry after industry, Apple have long been masters of this kind of reframing. When asked recently about their emerging interest in healthcare, Tim Cook said, “The focus has been on making products that can get reimbursed through the insurance companies, Medicare, or Medicaid… we bring a totally fresh view on this and say, ‘Forget all of that. What will help people?’.”
Designers can bring this approach to complex problems if we raise the conversation above individual products and services. Grounded futures enable us to visualize achievable fictions. In this case, we’ve found a future where an aging American population achieves better health and the companies who serve them see a better bottom line. What more could you want?
It is the mandate of the healthcare user experience designer to embrace the lived human experience of all those engaged in the system, but also to situate our work in a much deeper understanding of the context it inhabits. This series of articles seeks to lay out some of the complexities of the healthcare industry that are relevant to healthcare user experience designers. It’s a prime example of an industry where our standard user experience design tools are critical, but not sufficient. As a design community, we’ve mastered user-centered design, but when it comes to complex systems, sometimes we need to go further to have the impact we desire.
This design fiction has been a collaborative effort between myself and Moment designers, Mikel McCavana and Daniel Newman.