Merger Boom: What to expect from M&A and healthcare costs
Last month, the US. Department of Justice approved the merger of Cigna and Express Scripts, which together with the pending CVS-Aetna merger stands to re-shape the delivery of prescription drugs to consumers. As insurers like Cigna and Aetna gain more power over healthcare delivery, they are becoming ruthlessly more efficient in squeezing each part of the system to extract profit. However, much of this extraction process is hidden from public view.
Will Consolidations Live Up to Their Goals?
For prescription drugs specifically, the goal of consolidation is to achieve reduced costs by giving insurers control previously exerted by Pharmacy Benefit Managers (PBMs). This is done by creating formularies, mandating generic substitution and establishing step therapy for patients. This is a commendable goal, if those cost savings are actually passed along to consumers. But often they are not.
Separately, these and other practices ignore the needs of individual patients, particularly the poor, the elderly and those with unique and complex healthcare needs. These “outliers” are left to fend for themselves. Further, many of these patients rely on coupons to afford their medications, and PBMs are now developing coupon aggregator or maximising programs that shift more and more of the burden of payment to patients and individual pharmacies.
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Access is The Defining Issue
In other contexts, healthcare consolidation has resulted in patients being shepherded into ever tighter provider networks, left to pay ever higher out of pocket costs, particularly if they see an out-of-network provider. Recent mergers will similarly limit patient access for prescription drug therapies – in large by limiting coverage and increasing patient costs for non-routine therapies. Insurers and PBMs already have created havoc for patients through the use of co-payment aggregator and co-payment maximisation programmes, intended to shift costs to patients.
Living in an Age of Information
Today, clinical information about prescription drugs abounds. In theory, patients can and should take on a greater role in their healthcare, in partnership with their physician, pharmacist and other providers. But too often, getting a lucid explanation of insurer coverage and patient costs for any non-routine prescription drug therapy is a heroic undertaking. Particularly for elderly patients, accustomed to having their insurer cover whatever prescription drug the physician prescribes, change will be difficult. This lack of transparency makes it near-impossible for individual patients to assess the value of one prescription drug therapy versus another.
Add to all of this that there is minimal scrutiny of insurer and PBM rules for providers. No one knows if the rules an insurer applies to an independent pharmacy are the same as those applied to an insurer owned-and-operated pharmacy. Insurers and PBMs are notorious for creating ambiguous rules for independent pharmacies and then clawing back payments, particularly for disfavored or non-standard products. One assumes that insurers will not take a similar approach for their affiliated pharmacies.
PBM profits are irresistible – for example, while Aetna reported profits in 2017 of $1.9bn, CVS’s pharmacy services segment reported profits of $4.8bn. In theory, consolidation should allow insurers to leverage greater control to obtain lower costs for themselves and consumers. But in practice, things could be very different.
Check Point: Securing the future of enterprise IT
Cybersecurity solutions provider Check Point was founded in 1993 with a mission to secure ‘everything,’ and that includes the cloud. Conscious that nothing remains static in the digital world, the company prides itself on an ability to integrate new technology with its solutions. Across almost three decades in operation, Check Point, with its team of over 3,500 experts, has become adept at protecting networks, endpoints, mobile, IoT, and cloud.
“The pandemic has been somewhat of an accelerator in the evolution of cyber risk,” explains Erez Yarkoni, Global VP for Cloud Business. “We had remote workers and cloud adoption a long time beforehand, but now the volume and surface area is far greater.” Formerly a CIO for several big-name telcos before joining Check Point in 2019, Yarkoni considers the cloud to be “part of [his] heritage” and one of modern IT’s most valuable tools.
Check Point has three important ‘product families’, Quantum, CloudGuard, and Harmony, with each one providing another layer of holistic IT protection:
- Quantum: secures enterprise networks from sophisticated cyber attacks
- CloudGuard: acts as a scalable and unified cloud-native security platform for the protection of any cloud
- Harmony: protects remote users and devices from cyber threats that might compromise organisational data
However, more than just providing security, Yarkoni emphasises the need for software to be proactive and minimise the possibility of threats in the first instance. This is something Check Point assuredly delivers, “the industry recognises that preventing, not just detecting, is crucial. Check Point has one platform that gives customers the end-to-end cover they need; they don't have to go anywhere else. That level of threat prevention capability is core to our DNA and across all three product lines.”
In many ways, Check Point’s solutions’ capabilities have actually converged to meet the exact working requirements of contemporary enterprise IT. As more companies embark on their own digital transformation journeys in the wake of COVID-19, the inevitability of unforeseen threats increases, which also makes forming security-based partnerships essential. Healthcare of Ontario Pension Plan (HOOPP) sought out Check Point for this very reason when it was in the process of selecting Microsoft Azure as its cloud provider. “Let's be clear: Azure is a secure cloud, but when you operate in a cloud you need several layers of security and governance to prevent mistakes from becoming risks,” Yarkoni clarifies.
The partnership is a distinctly three-way split, with each bringing its own core expertise and competencies. More than that, Check Point, HOOPP and Microsoft are all invested in deepening their understanding of each other at an engineering and developmental level. “Both of our organisations (Check Point and Microsoft) are customer-obsessed: we look at the problem from the eyes of the customer and ask, ‘Are we creating value?’” That kind of focus is proving to be invaluable in the digital era, when the challenges and threats of tomorrow remain unpredictable. In this climate, only the best protected will survive and Check Point is standing by, ready to help.
“HOOPP is an amazing organisation,” concludes Yarkoni. “For us to be successful with a customer and be selected as a partner is actually a badge of honor. It says, ‘We passed a very intense and in-depth inspection by very smart people,’ and for me that’s the best thing about working with organisations like HOOPP.”