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The Business of Healthcare: One More Hat for Social Workers to Wear

Posted 14 August 2018 by Sean Powell

The Business of Healthcare:  One More Hat for Social Workers to Wear
In modern society data and information are available at our fingertips.  The effective practice of oncology social work requires that we stay abreast of the latest research on new treatment modalities, behavioral interventions, changes to social policy, resources, and population based science.  We all know and rely on The Journal of Psychosocial Oncology, Cancer, Google, and our own personal resources to find new information.  But, as a continual learner, researcher and advocate, how much time do you spend reading up on the business side of healthcare?   Probably not enough.  Your bag of resources should now include Forbes and Money.
We are in interesting times as the perception and delivery of healthcare is rapidly changing.  Your average American, if asked, would probably define healthcare as right, an undeniable service due all people.  We saw this reinforced with the approval of the Affordable Care Act in 2010.  However, in actuality, healthcare is a big business.  A really big business that makes and spends billions of dollars a year.   And as with all businesses, it must change with the times and continue to grow to remain solvent.
There have been two recent acquisitions that should be on every oncology social workers radar:  The purchase of Aetna by CVS/Coram and the purchase of PillPack by Amazon.  Why is this important to us?  Because these mergers could fundamentally transform cancer care and the way patients access healthcare services.   Let’s dive into this a little deeper.
CVS is the nation’s largest retail pharmacy provider, with over 9800 retail pharmacy outlets.  They also have 1,100 minute clinics.  They are the owner of Coram Specialty Infusion, which is one of the nation’s largest home based infusion and enteral nutrition companies.  Coram has recently expanded the service model and has begun opening their own infusion centers.  And they just bought Aetna, the nation’s largest insurance provider with over 21 million members.  It doesn’t take a genius level IQ to make some quick deductions.
An insurance company’s goal is to identify the highest quality, lowest cost care for its enrollees.  Having an in-house infusion and pharmacy would allow Aetna to control quality and costs.  It is not a far reach to imagine Aetna making CVS and Coram their preferred providers and requiring their enrollees to use these providers to obtain the highest benefit from their insurance plan.  This could seriously affect hospital based infusion centers which would lose business to Coram’s infusion centers.  Years of demonstrating the benefits of comprehensive cancer care would be undone by once again separating the locations of care delivery.  A more interesting jump would be that hospitals stop operating their own infusion services and lease space within their facility to Coram to operate an infusion center (Like Target did with CVS Pharmacy) or would chemo regimens previously administered in a center be delivered at home?  These types of changes directly impact our patients as well as our own practice, as our accessibility and the way we interface with patients would change.  

Secondly, Amazon purchased a mail order retail pharmacy.  This is big news.  Amazon is one of the world’s largest online retailers.   Due to Amazon’s size and their ability to negotiate pricing, Amazon could significantly reduce the costs of prescriptions.  And how much easier would it be if patients could reorder their prescriptions from their mobile device and have them delivered a few hours later.  Hospitals would no longer need bedside delivery as the patient’s medications could be waiting for them at home (except for narcotics).
Recently, I saw a demonstration where Amazon’s own Alexa was used to remind patient’s to take their medication.  Alexa could be used as a powerful tool to monitor patient’s prescription use, track information on side effects, automatically refill prescriptions, and send compliance reports or updates to the ordering providers. 

Cost and innovation are the biggest drivers of change in healthcare.  The two examples I outlined have the potential to dramatically change care delivery.  But, there is a political and legislative component: These changes could impact patient’s right to choice and privacy.  Remaining abreast of the business side of the healthcare landscape doesn’t just keep us informed and give us insight into where healthcare is headed, it also alerts us to the legislative needs of our population.  Do new consumer protections need to be enacted to ensure patient choice?  How does HIPAA apply to Alexa?  Can Amazon and the VA finally convince CMS of the long overdue policy changes needed to lower prescription drug costs for Medicare recipients?  What policy changes do we need to advocate for on a national, state, and local level that will protect our patients?
So, it is time for social workers to add one more hat to our rack, and that is knowledgeable healthcare business insider.   Our intimate knowledge of the patient experience and business and financial developments can truly inform our macro-practice and empower us to influence healthcare policy.  It is just one more way that social work plays a vital role within oncology and demonstrates the importance of a system perspective in delivering the best possible patient care.

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