More on Hospital/physician relations

Retail health a double-edged sword

Poised to serve two growing patient demographics, retailers are getting ambitious

More U.S. health systems could lose patients to retail companies if the seeds sown by the likes of CVS, Walgreens and Walmart take root.

Fresh from quitting tobacco sales, CVS is hoping to become a key part of the American healthcare ecosystem. Since its first MinuteClinic opened in 2000,CVS has become the largest retail clinic operator with its 877 locations in 27 states, including California, Florida and Texas.

The Woonsocket, R.I.-based company is beckoning consumers to its clinics, pharmacies and Medicare drug plan, trying to serve as a node for collaboration with hospitals. The company is sharing pharmacy and primary care data with more than 40 health systems, including Sharp in California, Emory in Georgia and MedStar in Maryland.

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Clinicians at health systems with a CVS-integrated electronic health record (EHR) can see all of a patient’s prescriptions across locations — a major boon to medication adherence and admission prevention efforts — while patients visit CVS for medication refills, groceries and housewares, or a check up on symptoms with a nurse practioner.

“It really goes back to today’s healthcare consumers looking for care when they want it,” as Bob Gilbert, MedStar’s president of ambulatory services, recently told Kaiser Health News.

[See also: Retail clinics popular with high earners.]

Chicago-based Walgreens, which operates 420 clinics in 21 states, is not yet quitting tobacco sales like CVS. But it is going after another large consumer health market for wellness and health rewards, in a partnership with WebMD. With the goal of incentivizing consumers “to make healthier choices at home, work and on-the-go,” the project will bring WebMD’s virtual wellness and coaching programs to the shoppers at its 8,000 stores.

Walgreens is going to incorporate WebMD content into its digital and mobile commerce platforms, while WebMED intends to offer visitors to its website — like individuals Googling their symptoms — access to Walgreens prescription refill and clinic appointment scheduling.

Walgreens intends to market WebMD’s virtual wellness programs for smoking cessation, exercise, weight control, stress reduction and chronic disease management, and link it to customer loyalty and rewards programs, to give consumers access to discounts and gift cards for healthy behaviors.

The Walmart effect

Meanwhile, Walmart, the largest retail chain in the national and world, is nurturing new insurance sales and primary care services, along with its pharmacy business.

After years of selling prescription drugs, co-branding Medicare drug plans and partnering with local hospitals and providers for some 100 walk-in clinics, Walmart is now going to be a provider itself — offering access to a nurse practitioner for $40, or $4 for the 1.1 million workers and dependents covered by the company health plan.

Staffed by a private company, six new Walmart Care Clinics in Texas and South Carolina, and others to come, will offer a range of low-cost lab services — $8 for bladder infection, cholesterol and mono tests and $15 for hemoglobin blood sugar, urine protein and HIV tests — and be open 8 to 5 Monday through Friday, 8 to 5 Saturdays and 10 to 6 Sundays.

The new clinics are aimed at “setting a new retail price in the healthcare industry,” said Jennifer LaPerre, Walmart’s senior director for health and wellness.

Low-cost basic care and preventative tests — at prices patients know before they receive them — along with evening and weekend hours and online appointments make retail companies well-suited to serve the millions of newly-insured individuals with subsidized private plans or Medicaid and baby boomers covered by Medicare.

Health systems can offer convenience and quality as well as retailers, and perhaps can meet affordable prices, if they start now — before waves of retail health really wash in.

“If there’s a Walmart clinic open 15 hours a day, that’s the standard you may have to meet,” said Lisa Bielamowicz, MD, the chief medical officer at the Advisory Board Company. Online and same day appointments and walk-in on-site lab tests “are eventually going to rise to be the standard,” Bielamowicz argues.

A number of health systems are trying to offer retail services at walk-in clinics, such as Alegent Health in Omaha (a part of Catholic Health Initiatives), Group Health in Seattle, and Geisinger Health System in Pennsylvania. In greater Philadelphia, Abington Health, Temple Health and Einstein Healthcare have opened walk-in clinics and now compete against private operators like Patient First and Premier Immediate Medical Care — and walk in clinics at CVS, Target, Walgreens and Walmart, places where many people are already shopping.

In rural regions, Walmart especially has a big opportunity to be a major provider of primary care for many people. Bielamowicz thinks the company could also expand its ideas and make more transformative investments. “You could see how they could evolve this strategy.”

In a presentation last year, she wondered: “What if Walmart expands enough in primary care that it disrupts local, established patient-physician relationships and referral chains, combines clinical, pharmacy and consumer data to create comprehensive patient profiles and then uses that to create a membership model that can drive patient decisions, and then on top of everything, they’re able to launch or partner with a nationwide affordable health plan and require aggressive price concessions to participate in their networks?"