The trend of brand-name retailers growing their presence in healthcare continues to build. In the past couple of years Amazon, CVS Health, and Walgreens have spent billions of dollars in acquisitions to stake their claim. From primary and specialty care to home health and retail health, these companies are betting on putting their years of experience creating innovative systems to work.
One of the main goals behind the retail trend is to make healthcare more accessible. Anyone who has tried to make a doctor’s appointment in the past couple of years can attest to the difficulties in accessing care. Certainly there is an appeal to going to Target and getting your flu shot, Covid booster, a cholesterol test, and paper towels and dishwasher pods in 30 minutes.
A couple of years ago, Jocelyn Konrad, former vice president of pharmacy and retail operations at Rite Aid, commented, “The consumer really wants the convenience of care, and they are embracing the convenience of care inside retail establishments because it’s a high level of care. You’re not sacrificing anything to come to a clinic inside a drug store.”
This movement begs the question — do we have the proper infrastructure in place to support this shift? Where are the benefits and where are the challenges?
Providers and patients are turning the tide
There is something alluring about access to care being more seamless, end-to-end, and for the masses. We’ve already seen a shift from some clinicians who, facing burnout, overwhelming staffing shortages, and an endless pandemic, have taken matters into their own hands. Many have left the establishment to start practicing medicine on their own terms in direct primary care. Others are going even further to become virtual-first clinicians. For primary care physicians, psychiatrists, mental health therapists, and other health professionals, there is a clarity that they are not tied to one avenue of practice anymore as the workplace has shifted throughout the pandemic years.
This shift holds true for patients as well who are rethinking how they want to access healthcare. Patients are no longer ill-informed or removed from their individual healthcare experience. They don’t have to wait three months to get an appointment with their primary care physician or jump through hoops to obtain their medical records. There is a broader menu to choose from via their laptop or an app on their smartphone.
“A focus on convenience really opens up the opportunity for growth in the industry. We are seeing that patient preference for health care and their knowledge about primary care has changed dramatically over the last decade,” said Tine Hansen-Turton, founding executive administrator and director of the Convenient Care Association. “The full complement of primary care health services available at conveniently located in-store clinics is driven by a community demand pushing and saying, ‘Provide more services.’”
This is the convenience and demand retailers are betting on to continue from healthcare consumers. An “Amazon-packaged” experience if you will. And sure, on-demand healthcare sounds amazing and accessible and holds the hope of ensuring more people can access care regardless of where they live or if they have transportation or can get the time off of work. However, a key element to the success and sustainability of this retail model is to consider what the potential drawback might be to a fast food approach to healthcare.
Understanding the gaps of retail care
It’s easy to see the benefits of applying retail models to healthcare. “If people would visit a clinic in the same place where they were shopping and getting their prescriptions filled, that would help to mitigate issues ranging from long ER wait times to the ballooning costs of healthcare,” some say. However, one potential gap in this strategy is how do you maintain a consistent physician/patient relationship built on history and trust? These deep-rooted relationships with patients are the crux of primary care and often seen as vastly important in the cycle of care throughout the patient’s life.
Data backs this up. One study found that positive relationships with physicians can help improve patient satisfaction and yield patient loyalty. When a patient has a regular source of healthcare, health outcomes can improve. Furthermore, researchers looking at 22 studies from nine countries, each with different health systems, found that regular contact with the same doctor resulted in fewer deaths over the study period in 18 of the studies.
Retail healthcare will certainly fuel greater access to care but likely not with the same physician each time. Some argue the benefits of forging that long-term, consistent relationship over time will be lost. However, research shows a declining number of Americans have a primary care provider. The proportion of U.S. adults with a primary care physician fell from 77% in 2002 to 75% in 2015. Among 30-year-olds, the proportion dropped from 71% to 64% in the same period.
It will also be important for these practices and clinics to keep up with the demand. This is where credentialing could play a big role. Credentialing is already a complex and challenging process, even for a small medical practice. The countless hours it takes practice staff to ensure all of their providers are in compliance with the extensive list of credentialing and insurance mandates is inefficient, to say the least. Delays and other administrative challenges are costly. CAQH research estimates that not automating administrative processes is costing providers about $9.5 million in savings. Additionally, commercial health plans and providers spend at least $2.1 billion annually to maintain provider databases; 75% of those costs could be offset by integrating with an external source of truth, if that existed.
Without a centralized system and process to credential providers, credentialing could be a bottleneck to the “supply” these larger retail and consumer-based models will need to keep things moving and sustainable at an Amazon-esque pace. Additionally, there is the issue of quality. You do not want to sacrifice finding quality, highly skilled clinicians for quantity, ease, and speed. There is going to be a big need for a unified process to credential these providers, which our current infrastructure does not have in place.
Last year, when Amazon acquired One Medical, Neil Lindsay, SVP of Amazon Health Services, said in a statement, “We think healthcare is high on the list of experiences that need reinvention.” Who would disagree? However, while this is true, and while retailers already have a customer service focus, there is a steep learning curve to healthcare and the nuances of how things operate. It will be critical that these brands do their due diligence and invest in innovations that work to improve the fundamentals of healthcare such as efficient provider credentialing and flexible and sustainable working practices for providers.
Photo: CVS Health