Fortune | FORTUNE 2024年10月21日
What went wrong at CVS 
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作者讲述儿子脚踝手术费用报销遭拒的经历,引出CVS Health旗下的Aetna所面临的问题。CVS面临多种挑战,Aetna被指医疗成本飙升且未被保费覆盖,其收购价高昂。过去Aetna也曾有过转型,新CVS首席面临诸多难题。

🧑作者儿子脚踝手术,作者预付超2万美元,费用报销遭拒,医生虽降费但仍未解决。Aetna、医院和雇主互相推诿,患者维权艰难。

🛒CVS Health拥有Aetna,面临多重挑战,包括股东要求变革,Aetna医疗成本飙升未被保费覆盖,且收购Aetna的价格高昂。

🌟过去Aetna曾有过成功转型,如CEO Jack Rowe将其从困境中转变为盈利且对医生友好的创新者,还采取收集成员种族数据等举措。

🙌Aetna是新CVS首席David Joyner面临的挑战之一,CVS要成功不仅需提升利润,还需解决更多问题。

Last year, when my son needed ankle surgery after a bad fall, I sent him to see Dr. John G. Kennedy, the director of the foot and ankle center at NYU Langone. Enrolled in Aetna through my previous employer, I reluctantly paid more than $20,000 upfront for the outpatient procedure, assuming I’d get most of it reimbursed, having maxed out on our annual out-of-pocket payments. Despite numerous appeals to Aetna, the hospital and the employer, I was stuck paying the entire bill. (The doctor had shaved $5,000 off the initial $25,500 cost after I said it was staggeringly high for this single mom.) My then-employer and NYU Langone both insisted the fault lay with Aetna, while the insurer gave various reasons in refusing to reimburse the doctor’s surgery cost. I vividly recall the frustration of the patient advocate at Aetna, who claimed it wasn’t always this tough to get paid.  That experience was in the back of my mind when reading about the struggles at CVS Health, which owns Aetna, and the ouster of CEO Karen Lynch last week. For a closer look at what went wrong, check out this piece by my colleague Shawn Tully. CVS faced multiple challenges, including an activist shareholder demanding changes at the top. But the company has blamed much of the pain on soaring medical costs at Aetna that were not covered by the cost of premiums. It doesn’t help that Lynch’s predecessor Larry Menlo paid a hefty $68 billion, or 73% premium, to buy Aetna in a deal that closed six years ago. I’ve had a lot of respect for Aetna over the years. This is not the first time it’s needed a turnaround. I saw CEO Jack Rowe, a noted geriatrician, transform Aetna from an insurer with a bleeding bottom line and a bullying reputation into a profitable and physician-friendly innovator about two decades ago. Among other things, Rowe made a controversial move to start collecting racial and ethnic data from its members back in 2002, enabling the company to better understand and address racial disparities in healthcare. Aetna was also early in crafting disease-management programs and related services to help people comply with treatment plans. Aetna is just one of the challenges now facing the new CVS chief David Joyner. (Geoff Colvin points out that the arrival of Roger Farah as executive chairman could help, too, given his track record at Ralph Lauren and elsewhere.) I’m no longer a member of Aetna; having canceled a family trip in part because of the claims cost, I may avoid being one again. To succeed, CVS will have to boost more than its bottom line. More news below. Diane Bradydiane.brady@fortune.comFollow on LinkedInTOP NEWSCVS CEO oustedCVS Pharmacy Corp. announced the exit of CEO Karen Lynch effective last Thursday, marking the departure of the highest-ranking female CEO on the Fortune 500. She was replaced by David Joyner, a longtime executive at the company. FortuneMark Cuban blasts Trump tariff proposalBillionaire Mark Cuban described former President Trump's plan to raise tariffs up to 20% on imports as a "tax on everybody" during a rally for Kamala Harris in Wisconsin last week. A proposed 60% tariff on Chinese imports would be particularly expensive for families and small businesses, Cuban said. FortuneOpenAI and Microsoft talk equityBoth OpenAI and Microsoft have hired their own banks to decide how much Microsoft, which has invested around $13.75 billion in the AI company, will hold in equity when OpenAI transitions to a for-profit business model, per the Wall Street Journal. FortuneAROUND THE WATERCOOLERThis is the web version of CEO Daily, a newsletter of must-read global insights from CEOs and industry leaders. Sign up to get it delivered free to your inbox.

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Aetna CVS Health 医疗成本 企业转型
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