There's a building threat from the nation's two retail drugstore giants to hospitals and health systems as providers move toward value-based care and lower-cost outpatient services.
Even with Amazon threatening to compete with retail drugstore chains CVS Health and Walgreens with its own online pharmacy, these retailers aren't giving up on brick-and-mortar as a way to attract more patients into their stores.
And that's bad news for the nation's hospitals and health systems.
There's a building threat from the nation's two retail drugstore giants to hospitals and health systems as medical care providers move away from fee-for-service medicine to value-based care and lower-cost outpatient services.
Walgreens and CVS are looking to healthcare as a way to keep customers coming into their stores, particularly in an era where consumers are fleeing brick-and-mortar to shop online via Amazon.
As front-end retail sales have fallen in recent years, CVS and Walgreens are moving more rapidly into healthcare from simply their historic role of filling prescriptions beyond the pharmacy counter and treating routine maladies with nurse practitioners in their retail centers to more services.
They are partnering more closely with health insurance companies that will work harder to funnel more patients to outpatient healthcare services inside the stores that will make them direct competitors of U.S. hospitals and health systems.
CVS has more than 1,100 retail MinuteClinics compared to 800 five years ago and 400 a decade ago.
CVS was opening 100 clinics per year 10 years ago, and that has slowed because they are now focusing on expanding healthcare services in the clinics as well as their stores generally. The same goes for Walgreens.
Walgreens has increased the services in its retail clinics, advertising the ability of nurse practitioners to conduct routine exams and student physicals and has been aggressively lobbying states across the country to change scope-of-practice laws to allow pharmacists to administer an array of vaccines.
"Why not use those locations as a strategy for healthcare?" Walgreens Chief Medical Officer Dr. Patrick Carroll says of the drugstore chain's nearly 10,000 locations across the country. "We have the space. We should use it."
To be sure, Walgreens is looking to provide more physician services like x-rays and procedures by partnering with UnitedHealth Group's Optum to connect its MedExpress brand urgent care centers to an adjacent Walgreens. Like most retailers, Walgreens' sales of general merchandise in the front end of the store is falling just as pharmacy sales, personal healthcare, and wellness revenues rise.
In the first such ventures, the Walgreens store and the MedExpress center each have their own entrance with a door inside connecting the urgent care center with the drugstore. It's designed for a medical provider to guide a patient to either facility depending on their prescription or other needs.
For now, there are 15 locations in six states that have MedExpress urgent care centers connected to Walgreens stores as part of the pilot. The markets include Las Vegas; Dallas; Minneapolis; Omaha, Nebraska; two cities in West Virginia; and Martinsville, Virginia.
"We're working closely with a number of partners in the healthcare community to bring services closer to our customers," Carroll said. "With our stores serving as more of a neighborhood health destination, we can best meet the changing needs of our customers, while also complementing our expanded pharmacy services."
Meanwhile, CVS plans to offer more healthcare services inside its stores after its merger with Aetna closes. CVS executives say they aren't ruling out developing urgent care centers as well.
CVS' network of nearly 10,000 pharmacies and over 1,000 retail clinics, and Optum's growing network of ambulatory facilities like the MedExpress urgent care centers are emerging as a model health insurers want to do business with as fee-for-service medicine gives way to value-based care that keeps patients out of the hospital.
And in CVS' case, the pharmacy will soon own Aetna, a health plan with more than 20 million members. That combination, which is currently wending its way through the regulatory process, is expected to lead to more narrow network health plans that encourage patients to use providers in the Aetna-CVS network over other health systems' facilities.
Health systems should be concerned, healthcare analysts say.
"CVS and Aetna, in their own words, are promising to reinvent the front door of American healthcare," says Kenneth Kaufman, managing director and chair of the consulting firm Kaufman Hall. "That promise should be of serious concern for legacy hospital providers since those providers have occupied that front door for the past 75 years."
CVS Health President and CEO Larry Merlo is beginning to offer some details to their strategies.
While cautioning that it's "very early" in the development of new programs the combined company will develop, Merlo has said the larger company plans to first focus on three primary patient populations: those patients with any of five chronic diseases: diabetes, hypertension, hyperlipidemia, asthma, and depression.
CVS and Aetna will also focus on "patients undergoing transitions in care," and a third "broader focus on managing high-risk patients," Merlo told analysts on the company's second quarter earnings call in May.
"By extending our new health care model more broadly in the marketplace, patients will benefit from earlier interventions and better connected care leading to improved health outcomes," Merlo said on September 20 at a CVS Health town hall meeting in Los Angeles.
"Think again about that senior leaving the hospital, knowing that the care plan prescribed by her doctor is being seamlessly coordinated by CVS and her caregiver. By fully integrating Aetna's medical information and analytics with CVS Health's pharmacy data and our 10,000 community locations, we can enable more effective treatment of the whole patient," he says.
Bruce Japsen is a contributing editor for HealthLeaders.