Retail Outlets Are Changing the Care Landscape

With patients becoming more engaged in their healthcare and increasing their focus on health and wellness, retail chains across the country are ready to show them what they can offer.

The number of visits to walk-in medical facilities at pharmacies, grocery stores and other retailers went from 1.48 million in 2007 to more than 10 million in 2011, according to a 2012 study published in Health Affairs.

Nearly half of the visits in the study occurred during weekends or other off-hours when doctors’ offices are typically closed, according to lead author Ateev Mehrotra, MD, MPH, associate professor in the department of healthcare policy at Harvard Medical School.

To meet demand, the number of clinics is increasing with 3,200 expected by the end of this year. Clinics also are expanding their services. Walgreens, for example, now helps manage chronic conditions such as high blood pressure, diabetes, high cholesterol and asthma.

Retail trends are very strong, says Timothy J. Theriault, Walgreens senior vice president and chief information, innovation and improvement officer, who spoke about Walgreens’ strategies for growth during a presentation at the Health Information & Management Systems Society’s 2014 annual conference.

With more than 8,200 U.S. store locations, Walgreens wants to both have a community presence and scale its products and services nationally if not internationally, he says.

The chain just signed its 100 millionth customer to its loyalty program. “That’s an opportunity to create relationships,” Theriault says. “We’re becoming more of a services organization that is relationship oriented as opposed to transaction oriented.”

Driving relationships

To drive those relationships, Walgreens is focusing on its pharmacists whom studies show are the most trusted provider in healthcare, Theriault says. “We expect to see them continue to practice at the top of their license.” The company also believes pharmacists are an underutilized resource so reformatted stores bring them out from behind the counter for more customer interaction.

Also impacting relationships is Walgreen’s award-winning app—the No. 1 healthcare app in America. “Through connected health and digital patient engagement, there’s a great opportunity for us to play in this space,” Theriault says. “A more connected healthcare system is better for everyone.”

Walgreens has made significant investments in its IT to establish that connectivity with cloud capabilities designed to make employees more productive and mobile. A data center ensures all data are encrypted and the company began the largest U.S. deployment of an EHR this spring.

All this infrastructure helps the chain keep in contact with primary care providers, Theriault says. “We are committed, any time we do immunizations, to send data to state registries and doctors.” Information exchange is an essential part of the company’s strategy, he adds. And, Walgreens is gearing up for increasing patient engagement. “We see more and more opportunities for self service and high-consumer engagement.”

He sees potential for providers to review data from wireless devices and reach out to patients. People with diabetes typically see the doctor when it’s convenient for the doctor, he says. The average diabetic sees his or her primary care provider four to six times a year but sees a pharmacist 19 times a year. “Technology can start to play a differentiating role and give people comfort and insight into their conditions. Patients shouldn’t have to be patient. Convenience is something we aspire to.”

Influence on readmissions

Walgreens’ efforts have shown important results in the kind of metrics the federal government is most interested in. For example, hospital patients who participated in Walgreens WellTransitions program were 46 percent less likely to experience an unplanned hospital readmission within 30 days of discharge, according to company research.

The pharmacist-led transition of care program collaborates with hospital systems to help patients better understand prescribed medications during their hospital stay and remain adherent after returning home.

Walgreens’ research examined 744 matched pairs of WellTransitions patients and non-patients in a retrospective case comparison study to evaluate the effectiveness of the program. “The actual connection to patients post-discharge was one of the most significant pieces contributing to the findings,” says Daniel Kwasigroch, Walgreens senior director of health systems, specialty and infusion. Pharmacists talk to patients about their discharge instructions and make sure they understand which medications to take to “get them on the right path to better outcomes.”

Walgreens’ pharmacists allocate time to do a complete medication review, says Kwasigroch, and then report back to physicians. The process is designed to support physicians, not replace them, he says. Pharmacists also reach out to physicians if they feel a patient requires immediate attention. Also built into the system are alerts for patients who don’t have the necessary follow-up appointments scheduled.

Growing & pioneering

CVS Caremark also is a pioneer in the retail healthcare market, opening its first MinuteClinic in 2000. MinuteClinic offer consumers “cost-effective, accessible, evidence-based care,” says Nancy J. Gagliano, MD, chief medical officer at MinuteClinic and CVS Caremark senior vice president.

Since the launch, MinuteClinics have performed 19 million patient visits. There are now 800 locations in 28 states employing 2,500 nurse practitioners.

Gagliano says much of MinuteClinic’s success is due to the shortage of primary care providers. “Half of the patients who come to us report they don’t have a primary care provider.” The chain encourages these relationships, however, by distributing a list of providers within a 10-mile radius to its MinuteClinic patients. In fact, one-third of MinuteClinic patients with a sore throat have elevated blood pressure, she says. “That’s a phenomenal opportunity to recommend a primary care provider.”

To ensure that MinuteClinic patients are receiving high-quality care, guidelines are embedded into its EHR which is routinely shared with providers, she says. “Physician collaboration is very important to us. We have a strong commitment to partnering with the local healthcare community. Our physicians and nurse practitioners get on the phone together once a month and develop a clinical rapport as opposed to an artificial rapport a state regulation might impose.”

Like Walgreens, CVS Caremark focuses on the convenience of the retail outlet. Half of MinuteClinic patients visit on weekends or in the evening. “People just don’t have access to care when they need it,” Gagliano says. Plus, the nurse practitioner spends an average of 22 minutes with each patient. That kind of attention results in patient satisfaction rates that are “through the roof.”

The retail market also has more experience with price transparency. MinuteClinics have a list of prices for each service. “For people with high deductibles, knowing the cost is important,” Gagliano says.

There is concern that this retail healthcare can undermine patients’ relationships with their primary care providers, says Health Affairs study author Mehrotra. “We know those patients with good primary care provider relationships typically have higher quality care and lower costs.” However, in almost two-thirds of retail clinic visits, patients reported no primary care relationship “so there is no relationship to undermine.” And, MinuteClinic visits offer significant cost savings compared with both traditional office visits (20 to 30 percent less) and emergency department or urgent care visits (70 to 80 percent less).

In another move changing the face of retail healthcare, CVS Caremark turned heads last fall when the company announced it will no longer sell cigarettes and other tobacco products as of Oct. 1. That decision translates into about $2 billion in lost sales but “ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health,” said Larry J. Merlo, president and CEO, in a release. “Put simply, the sale of tobacco products is inconsistent with our purpose.”

Looking ahead

“There is no reason retail health can’t be an arm of the care delivery system,” says Gagliano. “We view ourselves as an extension of the patient-centered medical home.” Traditional providers can start medications in an office setting and then a retail clinic can provide additional education or check blood sugar levels. Artificial regulations that prohibit that collaboration and affordable access “don’t make sense to me,” she adds.

Retail healthcare is going to continue to grow, says Mary Griskewicz, HIMSS’ senior director of health information systems. The convenience for consumers cannot be overlooked but she sees the potential for problems. For example, “patients might not tell their physician they got a flu shot. It is the patient’s responsibility to communicate that back because we don’t have systems that are interoperable.”

Griskewicz says there was a lot of interest in retail healthcare at HIMSS14. Clinicians wanted to hear about trends, IT professionals wanted to learn more and vendors were interested because many want to partner with such chains. “Most vendors would like to partner in the retail space. If you look at the growth of companies like Walgreens and CVS the uptick is there.”