Good morning.
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 Brady
diane.brady@fortune.com
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