- CVS Health will trial a coordinated care pilot for knee replacements in Aetna beneficiaries later this summer, CVS CEO Larry Merlo said at a Medicare Advantage conference in Washington on Tuesday.
- 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.
- The trial is the first in a series of initiatives CVS and its payer arm Aetna are working on, Merlo said, and will be available for as many patients as possible according to a spokesperson.
As CVS Health jockeys with Amazon and more traditional rivals like Walgreens, the retail pharmacy giant is looking to leverage two of its biggest assets going into the second half of the year — 10,000 brick and mortar locations and reams of claims data from its merger with Aetna.
The model aims to cut costs by reducing hospital readmissions amid a broader push to move care outside the hospital setting.
The volume of total joint replacements, like the knee or hip, has risen continuously over the past few decades as the population skews increasingly older. By 2030, total knee replacement is projected to grow by up to 189%, according to the American Academy of Orthopaedic Surgeons, and 90% of people who receive one report less pain from chronic conditions such as arthritis.
According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States. The number and relative safety of the procedure likely drove CVS' interest in the space fresh off its November closing of the Aetna merger.
In a video touting the approach showed at the conference Tuesday, an elderly knee replacement patient meets with a CVS case manager to make sure her surgeon is in-network, gets a home assessment to ensure safety post-operation and has a CVS representative help her pick out a cane and coordinate prescriptions.
"It's not just getting home from the hospital," Merlo said. "It's what happens in subsequent days and weeks in terms of a follow-up appointment with a physician or with physical therapy if it can't be provided in-home."
Though the CVS-Aetna integration isn't technically complete until a federal judge signs off on the settlement pact, the two companies have been joining their business operations for some time now.
"I'm really pleased with how the assimilation, the integration is going as we become one company," Merlo said, holding up the new trial as just one example of a "series of broad-based initiatives we're working on."
The company has been expanding its CVS HealthHUBs, retail locations that devote roughly 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.
Though a CVS spokesperson declined to say where CVS would be trialing the knee replacement model, the Dallas/Houston area — where CVS opened its flagship HealthHUB stores — could potentially be fertile ground for the healthcare company. East Texas has one of the country's highest rates of healthcare spending, according to the Health Care Cost Institute, and some of its worst health outcomes.
Wherever the knee replacement pilot will run, CVS will look for opportunities to expand to other conditions and procedures, the spokesperson confirmed.