The United States, as we’ve long been told, has the best health care system in the world. We have the best technology, top-notch medical providers, live-saving prescription drugs, and a free-market system that encourages innovation.
This opinion, though, is not universally agreed on. Critics point out that we have some serious issues in this country, starting with the way we pay for medical services. Health insurance is the key to accessing all of this great health care, yet millions of Americans are uninsured and have difficulty getting care when they need it. This is one of the arguments for a single-payer health care system like most other industrialized nations have.
Separate from the health insurance debate, though, most people will agree that health care is both inconvenient and expensive. It’s inconvenient because receiving care often means scheduling an appointment ahead of time, taking time off work, traveling to a provider’s office, and then waiting long past the time of your scheduled appointment because health care providers are notorious for running behind. And it’s terribly expensive, even for those who have health insurance. Indeed, the cost sharing requirements on health plans serve as a deterrent to receiving care; “consumer directed” plans are designed to make people think twice before going to the doctor.
These two barriers often cause people to go without needed care, and that can lead to more serious medical conditions.
But that might be changing. Recognizing the two primary barriers to accessing health care, the market has developed a variety of solutions that address either the cost or convenience issues. Some solutions address both.
Telehealth is a great example of a solution that solves both problems. A number of medical conditions can be diagnosed and treated over the phone, and a phone consultation with a physician is both cheaper and more convenient than an in-person doctor visit. Perhaps that’s why we now see telehealth expanding to supplement dermatology, mental health, and even dental visits in addition to acute primary care. The use of telehealth was already increasing exponentially before the pandemic, but with COVID-19 it has absolutely exploded. In an effort to avoid doctors’ offices, many of those who were on the fence about telehealth have given it a try and are now believers. It seems we’ve reached a tipping point and telehealth is here to stay. Many of the insurance products available through AHCP include telehealth visits at no cost to the member.
While retail clinics may not be super safe during a pandemic, they, like telehealth, are more convenient and less expensive than a traditional doctor visit. These sorts of retail clinics, often located inside a drug store or even a grocery store, have been growing in recent years, and with extended hours and affordable prices, they provide a convenient, cost-saving alternative for people who don’t have the time or money to go to see their family physician.
As you might imagine, not all doctors are big fans of retail clinics, though, as a recent article in Managed Healthcare Executive points out: “Physician groups, including the American Academy of Family Physicians and the American College of Physicians, have put out policy statements expressing reservations about the clinics possibly undercutting primary care, but retail clinics are now an established part of American healthcare delivery.”
The article also explains that, unlike some doctors’ offices, “retail clinics haven’t seen a drop in patient volumes since the outbreak began in mid-March.”
Health Hubs and Superstores
Many of the companies that currently operate retail clinics, including CVS and Walgreens, clearly have higher aspirations. While retail clinics are great for convenience or acute care for less serious conditions, they are not a substitute for the family physician for ongoing issues.
That’s why both companies are now creating “Health Hubs” designed to manage chronic conditions. The Managed Healthcare Executive article quotes James Beem, managing director of global healthcare intelligence at J.D. Power, who says that patients “still want to be able to have face-to-face consultations and be examined without a digital interface,” even during a pandemic. He goes on to say that Aetna, now owned by CVS Health, “may steer patients with chronic conditions to HealthHUBs,” which would make CVS Health “100% responsible for patient care and outcomes.” CVS plans to have 1,500 HealthHUBs by the end of 2021, and Walgreens expects to recruit 3,600 primary care providers over the next five years.
Another company that is expanding its health care footprint is Walmart, which, as Health Care Dive reports, is expanding its health “superstores” after opening a pilot location in Georgia. The company currently has five locations in Georgia and one in Arkansas, and will soon be opening additional stores in Chicago, Jacksonville, Orlando and Tampa. The health superstore “locations include primary and urgent care, dental and therapy and on-site diagnostic services.”
The company’s early experience with the Walmart Health stores has been positive. Currently about 50 percent of visits are booked by returning patients, who may now consider the locations to be their medical home. Half of the appointments that are scheduled are for primary care, while the other half are for specialty care, and “at some of the oldest locations, initial primary care visits are beginning to transition to more longitudinal chronic care management.”
Clearly, companies that operate retail clinics or even larger health hubs or superstores benefit from the fact that they have an in-store pharmacy. It’s easy to imagine that, after their doctor visit, most patients will simply fill their prescriptions at the pharmacy counter just a few feet away instead of taking the script to another pharmacy.
Still, millions of Americans take monthly maintenance drugs, and pharmacies continue to compete for their business. Mail-order pharmacies like Genius Rx are sure to gain market share as consumers remain cautious about being in public. One company that may soon prove to be an industry-changing competitor is Amazon. As CNBC reports, “Amazon is entering the pharmacy business with a new offering called Amazon Pharmacy, allowing customers in the United States to order prescription medications for home delivery, including free delivery for Amazon Prime members.”
The article goes on to say what may be obvious at this point: “For Amazon, the announcement is well timed. Americans are increasingly relying on getting their medicines via mail to avoid possible exposure to the coronavirus. That shift could be permanent, as more people than ever before are learning about new ways of receiving medication.”
Amazon acquired PillPack in 2018 and will rely on PillPack’s “pharmacy software, fulfillment centers and relationships with health plans” to make the company’s online pharmacy a success. Clearly, this development has competitors worried, as evidenced by tumbling stock prices for other pharmacies following the launch.
For brokers, it’s important to study the trends and be able to see where the market is going. As we look at the growth of telehealth, retail clinics and health hubs, and mail-order pharmacies, it’s pretty clear that cost and convenience are important to consumers; that’s why we’re seeing these solutions emerge. If our clients will soon be using these solutions (if they’re not already), we should be talking with them about these alternative ways or receiving health care and how their health plans cover these services. In other words, it’s much better to be proactive than reactive.