May 17, 2020

The Department of Justice has approved the merger of CVS and Aetna

Patient Care
USA
Aetna
M&A
Catherine Sturman
3 min
DOJ
The Department of Justice has approved the $69bn mega merger of health organization CVS with health insurance company, Aetna. The move will make the new...

The Department of Justice has approved the $69bn mega merger of health organization CVS with health insurance company, Aetna. The move will make the new business one of the largest drugstore chains in the US, including a major segment in delivering key health plans to consumers across its pharmacy benefit arm.

However, the approval has only been secured on the premise that the business sells its Medical Part D division to a subsidiary of WellCare as planned, which presently supports over two million US consumers.

Additionally, the DOJ has informed Aetna that it must enable WellCare to hire employees who are employed by this division.

In a recent statement, Larry J. Merlo, the chief executive of CVS Health, said that the approval “is an important step towards bringing together the strengths and capabilities of our two companies to improve the consumer health care experience.”

“In our new health care model, we provide people access to more affordable care when, where and how they need it,” he added. “Care will be coordinated among the health care providers, caregivers and their health care teams, leveraging the connectivity CVS will provide.

In 2017, CVS Health amassed $185bn in revenue, supporting more than 90mn customers. Aetna, on the other hand gained close to $60bn in revenue, providing essential health insurance to 22mn US consumers.

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However, many are concerned that consumers will be left with less choice and control over their healthcare, as well as higher healthcare costs. The move could also make it increasingly difficult for smaller pharmacy benefit management (PBM) players to gain further traction in the sector.

“This type of consolidation in a market already dominated by a few, powerful players present the very real possibility of reduced competition that harms consumer choice and quality,” George Slover, senior policy counsel for Consumers Union, an advocacy group, has publicly stated.

Consequently, those with Aetna health plans could be shoehorned into solely utilising CVS retail clinics, whilst those uninsured by Aetna could pay higher prices, creating significant issues for consumers.

Healthcare costs continue to rise, with medical spending currently consuming 18% of the US’ gross domestic product, CNBC reports. Medical costs have risen by an average of 5.5% each year since 2007, whilst US economy has grown by just over 3% since 1947.

However, traditional PBM’s are facing rampant competition from the technology sector, who can bring forth newfound solutions to the industry. Amazon’s acquisition of PillPack and its decision to partner with JP Morgan and Berkshire Hathaway sent shockwaves through the healthcare market, leading traditional players to urgently look for ways to remain competitive and find solutions fast in order to cater towards an evolving consumer market.

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Jun 14, 2021

Long haul Covid, the brain and digital therapies

#longcovid
#digitaltherapy
#neuroplasticity
#covid19
4 min
Neuroplasticity expert Ashok Gupta tells us about the symptoms of long Covid, how it affects the brain, and digital therapies

It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain. 

Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain. 

What is long Covid exactly? 

Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.

How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!

When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover. 

If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus. 

The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.

What symptoms does this cause? 

These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.

In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.

This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.

How does long-haul Covid affect mental health? 
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.

How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.” 

We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain. 

We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and  running half marathons again.

At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response. 

The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival. 

What digital therapies or apps are proving effective at treating long-haul Covid? 
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy. 

What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and  become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.

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