Rada Kleyman

About Rada Kleyman

Ms. Rada Kleyman is a Risk Manager at Libertate Insurance.

At Libertate Ms. Kleyman is inspired by the following mantra “prevention is better than cure”. She believes it is all about in avoiding and mitigating the effects which are essentially unavoidable. Her direct role and responsibility is to facilitate internal sales efforts as well as the servicing of existing PEO clients.

Ms. Kleyman brings a full complement of sales and management skills with over 28 years of successful experience. Highly effective in competitive environments with exceptional time management, strong interpersonal, presentation and closing skills which she acquired selling exotic cars for Ferrari of North America and prior to that Capital Medical Radiology Equipment Sales overseas. She is a recognized top performer, leading stores and accounts to exceed expected growth.

Ms. KIeyman is graduate of Northeastern University in Boston with a BS Degree in Criminology with a minor in African Art. She holds a General Lines (Prop & Cas) GL 2-20 license and 4-40 Customer Representative License.

Libertate Insurance LLC
Vigilant Insurance Representation
707 E. Washington Street, Orlando, FL 32801
844.571.0810
407.613.5475

House eyes workers’ compensation fee cap

By The News Service of Florida

TALLAHASSEE, Fla. – Fees for attorneys who represent claimants in workers’ compensation insurance cases would be capped at $150 an hour under a bill the Florida House considered Thursday.

Insurance & Banking Chairman Danny Burgess, a Zephyrhills Republican who is sponsoring the bill (HB 7009), told House members that the measure would help stave off workers’ compensation premium increases that, he said, will result in the next two years as a result of Florida Supreme Court opinions.

Related Headlines
Legal fees increase in workers’ comp system
Businesses to get workers’ comp rate cut
Workers’ compensation rate cut eyed
“We have an opportunity to be proactive,” Burgess said Thursday. “The crisis is still there.”

Business groups last year lobbied the Legislature to pass a workers’ compensation bill, arguing that premiums would otherwise increase because of a Supreme Court ruling that threw out strict caps on claimants’ attorney fees.

Lawmakers didn’t pass a workers’ compensation bill, though, and premiums didn’t go up.

Insurance Commissioner David Altmaier in November approved a final order lowering premiums by nearly 10 percent.

“The case made to us was a classic, sky is falling,” Rep Sean Shaw, D-Tampa, said, reflecting on the 2017 session and the push to act.

But Burgess said the nearly 10 percent reduction was the residual effect of sweeping changes the Legislature made to the workers’ compensation system in 2003.

Despite the reduction approved in 2017, Burgess reminded lawmakers that Altmaier approved a 14.5 percent increase in 2016.

Moreover, he said a recent Judge of Compensation Claims report on attorney fees showed that more than $75 million in hourly fees were approved for claimants’ attorneys in 2016-2017, a nearly 200 percent increase from the $25.8 million in hourly fees that were approved the previous year.

The House is slated to vote on the bill Friday

AmTrust Financial Services, Inc. Announces Formation of Special Committee to Review Proposal by Stone Point Capital, the CEO and the Karfunkel Family

PRESS RELEASE GlobeNewswire
Jan. 10, 2018, 08:30 AM

NEW YORK, Jan. 10, 2018 (GLOBE NEWSWIRE) — AmTrust Financial Services,Inc. (Nasdaq:AFSI) (the “Company” or “AmTrust”), announced that its board of directors appointed a special committee to consider the January 9, 2018, proposal from private equity funds managed by Stone Point Capital LLC, together with Barry D. Zyskind, Chairman and CEO of AmTrust, George Karfunkel and Leah Karfunkel (collectively, the “Karfunkel-Zyskind Family”), to acquire all of the outstanding shares of common stock of AmTrust that the Karfunkel-Zyskind Family does not already own or control for $12.25 per share in cash.

The special committee is composed of the following AmTrust directors: Donald T. DeCarlo, Susan C. Fisch, Abraham Gulkowitz and Raul Rivera. Mr. DeCarlo will serve as the chair of the special committee. AmTrust will not move forward with any transaction unless it is approved by the special committee. Any transaction would be subject to a non-waivable condition requiring the approval of a majority of the shares of the Company not owned or controlled by the Karfunkel-Zyskind Family, senior management or their respective affiliates.

Willkie Farr & Gallagher LLP will serve as the independent legal advisor to the special committee to assist in its review of the proposed transaction.

AmTrust Weighs Going Private with Stone Point Capital, CEO Zyskind

By Mark Hollmer | January 10, 2018

 

Stone Point Capital Partners, along with AmTrust Chairman and CEO Barry Zyskind and Director George Karfunkel (and his wife, Leah Karfunkel), have proposed to acquire all outstanding shares of AmTrust that they don’t already own.

A spokesperson confirmed that the bid, if accepted by the AmTrust board of directors and approved by shareholders, would take the New York-based multinational property/casualty insurer private.

The Karfunkel-Zyskind family owns or controls about 43 percent of outstanding shares of AmTrust common stock. They propose paying $12.25 per share for the rest of the company, a nearly 21 percent premium over AmTrust’s closing stock price on Jan. 8, 2018.

According to the announcement of the proposed share purchase, the idea behind the bid to take AmTrust private is designed, in part, to allow the carrier “to focus on the long term without the emphasis on short-term results.”

Expectations are that a special committee of independent AmTrust directors will consider the proposed transaction and then make a recommendation to the full board. Plans involve the special committee hiring on independent legal and financial advisers to help review the proposed share purchase.

For AmTrust to go private, the special committee must approve the proposed share purchase and shareholders outside of the Karfunkel-Zyskind family must also sign off on the idea. If the bid to go private does not go forward, “the Karfunkel-Zyskind family intend to continue as long-term stockholders of AmTrust,” according to their announcement.

A Busy Period
A move to take AmTrust private would cap a tumultuous period for the company.

In March, AmTrust delayed its 2016 annual report by a few weeks so it could conduct an audit and restate financial statements for the year, along with related disclosures for 2014 and 2015. After attributing the delay to its former independent auditor BDO USA, the company said it boosted its internal financial controls and also created a chief accounting officer position.

The insurer also took a number of initiatives over the past year to stabilize itself, including raising $300 million in new capital from the Zyskind family and the sale of its personal lines policy management system to National General Holdings for $200 million. The company also plans to make about $950 million by selling a majority equity interest in some of its U.S.-based fee business to private equity firm Madison Dearborn partners.

For the 2017 third quarter, AmTrust lost $174.7 million, compared to $80.7 million in net income during the 2016 third quarter. The company’s combined ratio also reached 134.4 for the quarter, compared to 93.2 in Q3 2016. Part of the issue stemmed from hurricanes and other extreme weather events, though Zyskind at the time said AmTrust was continuing to focus on promoting longer-term stability, raising money and improving its balance sheet.

Editorial: Illinois’ population loss shows why change is needed

The recent revelation that Illinois experienced the largest population loss of any state between July 1, 2016, and July 1, 2017, barely registered as a ripple.

That’s scary.

That Illinois continues to lose residents is hardly news, and is barely surprising, because it’s been happening for years — drip by drip, day by day.

That’s scary, too.

Consider: The state lost about 33,700 residents, according to the recent U.S. Census Bureau report. That’s more than half of Normal’s population packing up and moving out — which, given the recent tundra-esque weather pattern, would be somewhat understandable.

All kidding aside, the cold is actually a probable factor in our net migration. The Chicago Tribune in 2016 surveyed former Illinois residents and found weather was one of the reasons they moved out — many, it seems, are not that fond of living through four distinct seasons.

Locally, we’re holding our own. McLean County’s population has stayed relatively stable over the last several years. It rose from 169,572, according to the 2010 census, to an estimated 174,777 in 2013, before settling at 172,418 in 2016, the last year for which data is available.

Illinois is mostly equal in meteorological measures to our neighboring states. But what those states don’t have are the formidable difficulties of Illinois. The Tribune survey identified high taxes, crime, unemployment and financial problems in Springfield as the other influences for residents hitting the road — borne out, in part, by social media comments on any story about Illinois’ sad financial state.

We worry about this situation accelerating. We can’t keep following the pattern and expect different results. Every other Midwestern state has seen population growth over the past seven years, but not us.

Illinois ranks No. 1 for outbound moves on the 41st annual National Movers Study conducted by moving company United Van Lines.

That’s not a No. 1 we want. (New Jersey, our sister in high taxes and nonfunctional state government, was No. 2.)

Such hemorrhaging eventually raises the prospect of Illinois losing a seat in Congress. Our population is now 12,802,023 — and we’ve lost the fifth-most populous state title to Pennsylvania.

When will it end?

Not before we make serious changes, and it starts with government. Illinois’ real estate taxes, income taxes, property taxes and workers’ compensation insurance rates are embarrassments, as is the hangover of the two-year budget impasse and rampant deficit spending. It simply costs too much to do business here, especially compared to neighboring states.

We’re looking forward to voters remembering these issues when Election Day rolls around in November.

Texas Workers’ Compensation Costs Down 63% Since 2005

 

Austin, TX (WorkersCompensation.com) – More Texas businesses are providing workers’ compensation insurance as the cost of coverage continues to decline. Premiums have fallen by 63 percent since 2005 as the Division of Workers’ Compensation worked to reduce costs and improve care through health care networks, a drug formulary, safer workplaces, and other reforms.

In Texas, the average premium for each $100 of payroll dropped from $2.32 in 2003 to 86 cents in 2015, according to the National Council on Compensation Insurance.

The fact that fewer employees are filing workers’ compensation claims—a 28 percent drop since 2004, has contributed to the decline in premium costs. Non-fatal injury rates are also down 36 percent since 2005, an indication that employers are making workplaces safer.

“With premium costs down more than 60 percent, more employers have opted to provide workers’ compensation insurance, which means financial resources are there for injured employees when they need help the most,” said Texas Commissioner of Workers’ Compensation Ryan Brannan. “And in Texas, employees are also getting better care.”

More employees are getting treatment sooner. About 84 percent of injured employees receive non-emergency medical care within seven days of their injuries, compared to 76 percent in 2000. The average number of claims treated by physicians decreased over the last decade, from 21 claims per physician in 2000 to about 15 per physician in 2016.

“Looking at the numbers and the trends, we also see that injured employees are getting healthy and back to work faster than ever,”, Brannan said.

In Texas, more injured employees are back at work within six months of their injury, and the average number of days off work has decreased by more than 30 percent since 2005.

Rada Kleyman
Risk Manager

Workers’ Compensation is Highest Risk Sector

Source: WorkCompAcademy.com

Sacramento, CA – According to a new A.M. Best Co. Inc. special report,the U.S. workers compensation industry experienced more financial impairments during a 17-year period from 2000-2016 than any other property/casualty line of business.

Best defines impairments as being situations in which a company has been placed, via court order, into conservation, rehabilitation and/or insolvent liquidation.

Overall, 354 property/casualty insurers became impaired during the study period.

Supervisory actions undertaken by insurance department regulators without court order were not considered impairments for this study unless delays or limitations were placed on policyholder payments, Best said in a statement.

According to the study, the workers compensation sector accounted for 26% of the impairments; commercial lines insurers represented 22% of the impairments, split between other liability/commercial multi-peril at 15% and commercial auto at 7%; and 23% of impairments were split among specialty lines. The remaining sectors accounted for personal lines.

Specific causal factors were identified for 91 of the impairments, with fraud or alleged fraud the leading cause and present in 23 of the impairments, while 21 impairments related primarily to affiliate problems.

Catastrophe losses, largely in Florida and Texas, were responsible for 18 impairments, while 16 companies suffered impairment after experiencing rapid growth, the according to the statement.

Of the 354 impaired companies during the period, 45% were rated by Best at some point during the period between the date of impairment and three prior year-ends.

The study concludes that there has been a significant decline in the number of impairments that Best has been involved in rating in recent years. From 2007-2016, there were 174 U. S. property/casualty impairments, of which 21% were rated by Best at a point during the period between date of impairment and three prior year-ends, compared with 45% for the 2000-2016 period, according to the statement.

Rada Kleyman
Risk Manager

How the CVS, Aetna Deal Will Overhaul Healthcare Big Data Analytics

 – The CVS Health takeover of Aetna has technophiles and analytics pundits abuzz for a number of reasons, many of which have to do with the fundamental reshaping of the consumer landscape in Jeff Bezos’ image.

The looming specter of Amazon and its ability to get its tentacles wrapped around new market sectors with uncanny ease has raised speculation that CVS is making a calculated strike at consumer-driven healthcare before Amazon can find purchase in one of the most lucrative industries still waiting for its makeover moment.

But the most significant short-term implications of the marriage between retail health, pharmacy care, and payer services will likely have less to do with the jockeying of stock market giants and more to do with the increasingly important role of big data in lowering costs and improving outcomes.

At the moment, pharmacy data tends to be a half-step out of sync with the rest of the clinical world.

While the use of electronic prescribing among physicians has risen steadily since the beginning of the decade, and the vast majority of pharmacies can accept electronic prescribing data, that information doesn’t always make it back to population health management programs that need to understand medication adherence rates and patient challenges.

READ MORE: How the Healthcare “Value Chain” Leads to Big Data Analytics Success

Unfilled prescriptions are not routinely reported to primary care providers, who assume the patient is remaining adherent unless specifically told otherwise, and patients are rarely reminded that they have let a prescription lapse.

Medication non-adherence was a $337 billion problem in 2013, contributing to avoidable readmissions, higher emergency department use, and worse outcomes for chronic disease patients.

In one 2016 study, medication non-adherence affected 70 percent of patients prescribed statins for high cholesterol.  Patients cited a lack of engagement, communication, and chronic disease management support as some of the reasons why they did not stick to their recommended regimens.

On the provider side, healthcare organizations continually blame fragmented data access and a widespread lack of analytics power to identify high-risk patients as reasons why their population health management efforts are less-than-optimally effective.

new survey by SCIO Health Analytics found that 58 percent of providers believe inadequate big data access is preventing them from ascertaining the total cost of care for their patients, while 20 percent added that missing data types, such as socioeconomic and behavioral health data, makes it impossible to gain visibility into the complete patient story.

READ MORE: Amazon Machine Learning, Big Data Tools Have Healthcare Implications

More than a third of providers said lackluster big data means they are unable to close care gaps that have a significant impact on clinical and financial outcomes for patients.

Both Aetna and CVS Health have championed the importance of risk stratification, data-driven targeting for population health interventions, and the need for real-time big data shared across the care continuum.

CVS has invested heavily in electronic health record technology from Epic, which gives it the same data analytics firepower as many of the top hospitals and health systems in the nation.  The recent addition of Epic’s Healthy Planet population health management platform was intended to create more visibility into prescribing patterns and adherence rates.

And just days before announcing the Aetna acquisition, CVS Caremark, the pharmacy benefit manager (PBM) arm of CVS Health, launched a new service that enables real-time access to beneficiaries’ individual drug costs, deductible amounts, and prior authorization requirements.

“Patients often do not find out that the medication they were prescribed is not covered or has higher than expected out-of-pocket costs until they go to the pharmacy to pick up their prescription, which can result in patients not filling a prescription, non-adherence and, ultimately, higher downstream health care costs,” said Troyen A. Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health.

READ MORE: Using Risk Scores, Stratification for Population Health Management

“Making detailed, real-time benefit information available for our PBM members and their health care team, whether it’s the doctor or the pharmacist, can help streamline the patient experience and improve health outcomes while also lowering costs for both the patient and the payer,”

For its part, Aetna has been active in the accountable care organization (ACO) space, which requires open communication with providers around population health, quality, and spending – although a series of financial setbacks has drawn the public eye more towards its troubles than its successes.

failed attempt at a merger with Humana, the payer’s complete withdrawal from the Affordable Care Act health insurance exchanges, its decision to leave AHIP, and now the submission to acquisition have painted a difficult picture of the insurer in 2017 and 2018.

But Aetna has a strong big data analytics pedigree and deep experience with population health management – so much so that CVS Health President and Chief Executive Officer Larry J. Merlo prominently highlighted the company’s analytics chops in his public statement about the acquisition.

“With the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals,” he said.

“We look forward to working with the talented people at Aetna to position the combined company as America’s front door to quality health care, integrating more closely the work of doctors, pharmacists, other health care professionals and health benefits companies to create a platform that is easier to use and less expensive for consumers.”

Readmissions could be halved if patients and providers had complete visibility into their medications after discharge, the press release claims.

“In addition, home devices to monitor activity levels, pulse, and respiratory rates can be used to prevent readmissions. Rather than feeling lost and confused, selected high risk patients discharged from the hospital, or their caregivers, will be able to stop at a health hub location to access services such as medication evaluations, home monitoring and use of durable medical equipment, as needed,” said the release.

“All of these services will complement and be integrated with the care provided by their physician and medical team.”

That brings CVS to the primary reason why adding a payer to its network of pharmacy locations and growing investments in retail clinics could be a genius move for patients, not to mention CVS shareholders.

Part of the reason why Amazon is so successful – and why the CVS-Aetna deal is inviting such strong comparisons – is its ability to collect huge volumes of disparate consumer data and generate highly-targeted suggestions for individuals based on previous purchase patterns and the profiles of similar individuals.

With the addition of claims data, CVS will be adding an important new weapon to its already-impressive consumer health arsenal: not only does it already have access to pharmacy data and some basic health maintenance information from its retail clinics, but it also understands what over-the-counter drugs are purchased at its stores…and how often the individual adds a bag of potato chips, a chocolate bar, or a sugary drink.

Adding claims data to the mix gives CVS visibility into patient health behaviors on a much deeper level, and may enable the company to merge the retail analytics of an Amazon storefront with the clinically-driven population health management analytics of an Epic Systems healthcare provider client.

Integrated clinical and pharmacy benefits have already been proven to lower costs and improve patient engagement around certain chronic diseases, Aetna has said.

The strategy can reduce medical spending by up to $117 per member per month, a recent study showed, while reducing hospital admissions and emergency department use.

For patients, the results of this big data melting pot could be transformative.

While CVS may not go so far as to buy or develop its own comprehensive primary care network or inpatient setting run by physicians, it is likely that it will expand its presence in the retail clinic environment, or perhaps purchase some well-equipped urgent care clinics that have already established themselves in the community.

This could create a brand new healthcare delivery segment: mid-level care sites with a co-located pharmacy that are also directly linked to a patient’s payer.

Turning the traditionally cash-based segment of urgent care into a payer-backed alternative to primary care could generate a significant revenue stream for CVS and solve one of the biggest problems of preventive care for patients: catching and treating low-level complaints that patients don’t feel are worth the rigamarole of a full-fledged primary care appointment.

If the patient’s payer has direct access to that data, that is one less point of interoperability that has to be established between the traditional primary care segment and retail clinics.  PCPs will access retail clinic data and pharmacy data the same way they access claims data.

A single, comprehensive data packet will serve to inform primary care providers about medication adherence and prescription spending, retail clinic use for ear infections or flu shots, and claims submitted from hospitals, emergency departments, specialists, and any other care sites.

For a primary care provider quarterbacking a chronic disease patient, this could be a huge benefit – especially because the data will already be in standardized formats generated by Certified EHR Technology (CEHRT) from a vendor that has made interoperability one of its flagship causes.

Bringing the care continuum that much closer together could drastically improve population health and chronic disease management, enable the delivery of proactive alerts based on targeted risk scoring, and lead to lower costs on medications, utilization spending, and even plan premiums.

The challenge for other health plans – and for Walgreens, which is CVS’s main competitor in the retail clinic space – will be to establish similarly innovative partnerships with key players across the care continuum.

Some of the big players have already started to make their moves.  Walgreens, which together with CVS owns about three-quarters of the existing retail clinics, has also invested in Epic Systems technology.  Anthem, after weathering a damaging data breach and a similarly failed mega-merger, has poached part of its big data analytics team from the retail sector in a bid to make its care even more consumer-centered.

The mashup of cost and utilization data, customer experience metrics, care management, and strategic positioning will continue to be a “competitive differentiator” for payers as they jostle for position in a sector that has suddenly taken a sharp turn away from the norm.

Whether CVS will successfully lead the pack in a new direction – and what direction that might end up being – remains to be seen, but the purchase of Aetna could turn out to be a very shrewd move that aligns retail-style customer service with better population health, resulting in lower costs and a more seamless experience for beneficiaries.

By Jennifer Bresnick

How the CVS, Aetna Deal Will Overhaul Healthcare Big Data Analytics

The CVS Health takeover of Aetna has technophiles and analytics pundits abuzz for a number of reasons, many of which have to do with the fundamental reshaping of the consumer landscape in Jeff Bezos’ image.

The looming specter of Amazon and its ability to get its tentacles wrapped around new market sectors with uncanny ease has raised speculation that CVS is making a calculated strike at consumer-driven healthcare before Amazon can find purchase in one of the most lucrative industries still waiting for its makeover moment.

But the most significant short-term implications of the marriage between retail health, pharmacy care, and payer services will likely have less to do with the jockeying of stock market giants and more to do with the increasingly important role of big data in lowering costs and improving outcomes.

At the moment, pharmacy data tends to be a half-step out of sync with the rest of the clinical world.

While the use of electronic prescribing among physicians has risen steadily since the beginning of the decade, and the vast majority of pharmacies can accept electronic prescribing data, that information doesn’t always make it back to population health management programs that need to understand medication adherence rates and patient challenges.

READ MORE: How the Healthcare “Value Chain” Leads to Big Data Analytics Success

Unfilled prescriptions are not routinely reported to primary care providers, who assume the patient is remaining adherent unless specifically told otherwise, and patients are rarely reminded that they have let a prescription lapse.

Medication non-adherence was a $337 billion problem in 2013, contributing to avoidable readmissions, higher emergency department use, and worse outcomes for chronic disease patients.

In one 2016 study, medication non-adherence affected 70 percent of patients prescribed statins for high cholesterol.  Patients cited a lack of engagement, communication, and chronic disease management support as some of the reasons why they did not stick to their recommended regimens.

On the provider side, healthcare organizations continually blame fragmented data access and a widespread lack of analytics power to identify high-risk patients as reasons why their population health management efforts are less-than-optimally effective.

new survey by SCIO Health Analytics found that 58 percent of providers believe inadequate big data access is preventing them from ascertaining the total cost of care for their patients, while 20 percent added that missing data types, such as socioeconomic and behavioral health data, makes it impossible to gain visibility into the complete patient story.

READ MORE: Amazon Machine Learning, Big Data Tools Have Healthcare Implications

More than a third of providers said lackluster big data means they are unable to close care gaps that have a significant impact on clinical and financial outcomes for patients.

Both Aetna and CVS Health have championed the importance of risk stratification, data-driven targeting for population health interventions, and the need for real-time big data shared across the care continuum.

CVS has invested heavily in electronic health record technology from Epic, which gives it the same data analytics firepower as many of the top hospitals and health systems in the nation.  The recent addition of Epic’s Healthy Planet population health management platform was intended to create more visibility into prescribing patterns and adherence rates.

And just days before announcing the Aetna acquisition, CVS Caremark, the pharmacy benefit manager (PBM) arm of CVS Health, launched a new service that enables real-time access to beneficiaries’ individual drug costs, deductible amounts, and prior authorization requirements.

“Patients often do not find out that the medication they were prescribed is not covered or has higher than expected out-of-pocket costs until they go to the pharmacy to pick up their prescription, which can result in patients not filling a prescription, non-adherence and, ultimately, higher downstream health care costs,” said Troyen A. Brennan, MD, Executive Vice President and Chief Medical Officer of CVS Health.

READ MORE: Using Risk Scores, Stratification for Population Health Management

“Making detailed, real-time benefit information available for our PBM members and their health care team, whether it’s the doctor or the pharmacist, can help streamline the patient experience and improve health outcomes while also lowering costs for both the patient and the payer,”

For its part, Aetna has been active in the accountable care organization (ACO) space, which requires open communication with providers around population health, quality, and spending – although a series of financial setbacks has drawn the public eye more towards its troubles than its successes.

failed attempt at a merger with Humana, the payer’s complete withdrawal from the Affordable Care Act health insurance exchanges, its decision to leave AHIP, and now the submission to acquisition have painted a difficult picture of the insurer in 2017 and 2018.

But Aetna has a strong big data analytics pedigree and deep experience with population health management – so much so that CVS Health President and Chief Executive Officer Larry J. Merlo prominently highlighted the company’s analytics chops in his public statement about the acquisition.

“With the analytics of Aetna and CVS Health’s human touch, we will create a health care platform built around individuals,” he said.

“We look forward to working with the talented people at Aetna to position the combined company as America’s front door to quality health care, integrating more closely the work of doctors, pharmacists, other health care professionals and health benefits companies to create a platform that is easier to use and less expensive for consumers.”

Readmissions could be halved if patients and providers had complete visibility into their medications after discharge, the press release claims.

“In addition, home devices to monitor activity levels, pulse, and respiratory rates can be used to prevent readmissions. Rather than feeling lost and confused, selected high risk patients discharged from the hospital, or their caregivers, will be able to stop at a health hub location to access services such as medication evaluations, home monitoring and use of durable medical equipment, as needed,” said the release.

“All of these services will complement and be integrated with the care provided by their physician and medical team.”

That brings CVS to the primary reason why adding a payer to its network of pharmacy locations and growing investments in retail clinics could be a genius move for patients, not to mention CVS shareholders.

Part of the reason why Amazon is so successful – and why the CVS-Aetna deal is inviting such strong comparisons – is its ability to collect huge volumes of disparate consumer data and generate highly-targeted suggestions for individuals based on previous purchase patterns and the profiles of similar individuals.

With the addition of claims data, CVS will be adding an important new weapon to its already-impressive consumer health arsenal: not only does it already have access to pharmacy data and some basic health maintenance information from its retail clinics, but it also understands what over-the-counter drugs are purchased at its stores…and how often the individual adds a bag of potato chips, a chocolate bar, or a sugary drink.

Adding claims data to the mix gives CVS visibility into patient health behaviors on a much deeper level, and may enable the company to merge the retail analytics of an Amazon storefront with the clinically-driven population health management analytics of an Epic Systems healthcare provider client.

Integrated clinical and pharmacy benefits have already been proven to lower costs and improve patient engagement around certain chronic diseases, Aetna has said.

The strategy can reduce medical spending by up to $117 per member per month, a recent study showed, while reducing hospital admissions and emergency department use.

For patients, the results of this big data melting pot could be transformative.

While CVS may not go so far as to buy or develop its own comprehensive primary care network or inpatient setting run by physicians, it is likely that it will expand its presence in the retail clinic environment, or perhaps purchase some well-equipped urgent care clinics that have already established themselves in the community.

This could create a brand new healthcare delivery segment: mid-level care sites with a co-located pharmacy that are also directly linked to a patient’s payer.

Turning the traditionally cash-based segment of urgent care into a payer-backed alternative to primary care could generate a significant revenue stream for CVS and solve one of the biggest problems of preventive care for patients: catching and treating low-level complaints that patients don’t feel are worth the rigamarole of a full-fledged primary care appointment.

If the patient’s payer has direct access to that data, that is one less point of interoperability that has to be established between the traditional primary care segment and retail clinics.  PCPs will access retail clinic data and pharmacy data the same way they access claims data.

A single, comprehensive data packet will serve to inform primary care providers about medication adherence and prescription spending, retail clinic use for ear infections or flu shots, and claims submitted from hospitals, emergency departments, specialists, and any other care sites.

For a primary care provider quarterbacking a chronic disease patient, this could be a huge benefit – especially because the data will already be in standardized formats generated by Certified EHR Technology (CEHRT) from a vendor that has made interoperability one of its flagship causes.

Bringing the care continuum that much closer together could drastically improve population health and chronic disease management, enable the delivery of proactive alerts based on targeted risk scoring, and lead to lower costs on medications, utilization spending, and even plan premiums.

The challenge for other health plans – and for Walgreens, which is CVS’s main competitor in the retail clinic space – will be to establish similarly innovative partnerships with key players across the care continuum.

Some of the big players have already started to make their moves.  Walgreens, which together with CVS owns about three-quarters of the existing retail clinics, has also invested in Epic Systems technology.  Anthem, after weathering a damaging data breach and a similarly failed mega-merger, has poached part of its big data analytics team from the retail sector in a bid to make its care even more consumer-centered.

The mashup of cost and utilization data, customer experience metrics, care management, and strategic positioning will continue to be a “competitive differentiator” for payers as they jostle for position in a sector that has suddenly taken a sharp turn away from the norm.

Whether CVS will successfully lead the pack in a new direction – and what direction that might end up being – remains to be seen, but the purchase of Aetna could turn out to be a very shrewd move that aligns retail-style customer service with better population health, resulting in lower costs and a more seamless experience for beneficiaries.

By Jennifer Bresnick