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Most people wouldn’t think of CVS, Kroger, Walgreens, Walmart or Costco as their primary care home. Even fewer would consider these retailers as their behavioral health provider location. However, each of these retail giants is reaching for larger portions of the health care marketplace to supplement their core business.
Consumers, frustrated by ever rising health care deductibles and out of pocket costs and accustomed to immediate access to goods and services, are turning to urgent care and in store clinics for more of their health care needs.
A Definitive Healthcare report1 states that retail clinic claims have increased 200% since 2017 while primary care visits declined 13%. Their research found that 90% of the retail clinics are owned by six organizations, with CVS owning 63% of the market share by number of locations. Of the 1,800 retail clinics in the report, only 2% were in rural areas and 6 states had no retail clinics at all.
Costco recently announced it is offering discounted direct pay medical and mental health services for its members
Following this medical clinic model of health care and with the expansion of telehealth services, retailers are also getting into the business of mental health. A report by Behavioral Health Business2 details how CVS, Kroger, Walgreen’s and Walmart are offering in person and telehealth services to their customers. Similarly, Costco recently announced it is offering discounted direct pay medical and mental health services for its members.
While some of the behavioral health providers with these retailers do accept insurance most are cash only, paid by the consumer. In a nonscientific review of CVS’s HealthHUB™, advertised as “Your neighborhood place for wellness support”, there were no in person behavioral health providers and only 1 virtual behavioral health provider in Ohio, my home state, and none of either in the adjacent states of Kentucky and Indiana.
While this “integration” may be good for business (increasing traffic, new service lines, boosting prescription sales), is it good for consumers? There is no question that near immediate service can be a blessing for specific conditions and at specific times.
I found myself in this exact situation early this year when traveling out of state for work and finding myself with an intensifying case of strep throat. A walk-in appointment and prescription in hand in less than an hour was exactly what I needed. I can’t imagine how this might have looked if it were a mental health crisis vs strep throat or if I had traveled to a rural area with no clinics to be found.
While retail health care does address some systemic issues, such as reaching those who do not have a primary care provider and diverting some patients from the emergency room, it solves few of the problems with the current health care system. It doesn’t increase the number of primary care or behavioral health providers. It doesn’t increase the resources in underserved areas and in locations unfavorable to retailers. It doesn’t improve continuity of care.
Bearing the full cost of care in cash or credit is a barrier to many people even if that care is discounted. Retail health care is cheaper in part because it isn’t saddled with all the costs associated with providing comprehensive primary care to a panel of patients.
The blessing of comprehensive primary care is the relationship between the consumer and the primary care provider over time. Primary care provides preventative care, can identify problems early as well as treat and monitor chronic conditions. Primary care sees the whole of the patient and can help to co-manage conditions with specialists including integrated behavioral health providers. Integrated behavioral health provides a primary behavioral health home and should be our standard of care.
Consumer driven health care will likely always require access to urgent, single visit health care with predictable pricing at convenient locations including telehealth. It is not, however, a substitute for comprehensive integrated primary care.
A Fierce Healthcare report3 summarizes the ways traditional health systems can work more closely with urgent care and retail clinics to provide a more robust system of care. Health systems partnering with retail clinics, fostering interoperability between electronic health records and better referral processes are mentioned as ways to provide more seamless care for patients. Mirroring a less comprehensive option for behavioral health based on the retail medical clinic model isn’t a big step forward.
1. https://www.definitivehc.com/resources/research/retailers-healthcare
2. https://bhbusiness.com/2022/02/17/the-retailization-of-mental-health-in-urgent-care-has-begun/
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