CVS and the Dirty Secret of Medicine: Is our bottom line the same?

This piece was co-authored by my friend and colleague Dr. Jessica Schumer. Follow her on twitter @schumerj.

Last week there was a seismic shift in the healthcare marketplace. Did you feel it? CVS publicly announced plans to stop selling tobacco in its stores and simultaneously declared itself a major player in our nation’s healthcare system. According to CVS’ CEO Larry Merlo, “by removing tobacco products from [its] retail shelves, [CVS] will better serve [its] patients, clients and healthcare providers while positioning CVS Caremark for future growth as a healthcare company…This is the right thing to do.”

A healthcare company? Does selling medicine make you a healthcare company?

With a growing number of newly insured patients and a shrinking physician workforce, innovation is needed to stretch resources in a smart way, and CVS is paying attention. The recent passage of the Affordable Care Act (ACA) offers a new opportunity to re-envision the delivery of medical care in the US. Last week, CVS made a power move to take advantage of this opportunity and share in the profits of one of our nation’s largest industries. In the last 10 years, retail clinics have arisen as the in-store solution to the increased demand for primary care services, including vaccinations and urgent care. Leveraging the talents of our nation’s nurse practitioners, these clinics offer convenience at a competitive cost, and it is estimated they are serving 6 million patients per year. According to Larry Merlo, CVS’ “26,000 pharmacists and nurse practitioners [are already] helping patients manage chronic problems like high cholesterol, high blood pressure and heart disease.” But is that enough?

The short answer is no.

CVS may be the place for a quick vaccine or office visit, sure, but what if you need something more? What happens when CVS’ retail clinic doesn’t have what you really need? What are the implications of receiving piecemeal care that may be convenient and accessible, but is so limited in scope it is unable to provide the comprehensive, coordinated and community-based care required to address complex, chronic medical conditions.

What is the right thing to do?

CVS has found an interesting and important niche in the healthcare marketplace. It is offering relatively affordable care for a number of routine patient complaints. Going forward, hospitals and clinics should consider partnering with CVS to leverage its resources in serving these specific health care needs. After all, we call it a health care system for a reason. It works best when all the pieces and parts work in concert to serve the whole. The key is finding a way to encourage retail clinics to do what they can do and not pretend to do what they cannot.

Today, poverty and economic inequality are driving many of the major health problems in our country. Healthcare organizations that do not address these issues in their care models risk exacerbating the core problems underlying chronic disease. Part of the brilliance of the ACA is the focus on medical homes – a clinical foundation for every patient problem, including the ones that originate outside the clinic, in the community. Medical homes offer continuity of care, coordinated specialty care, and community engagement. They are not where you buy your prescription medicines, they are the community-based drivers of overall good health and wellness. In addition, the convenience of the retail clinic model lends itself to serving low income communities who may disproportionately rely on proximity to services when selecting where to receive their care. While these clinics may have a long way to go to engage underserved populations and appropriately integrate their operations with local medical homes, they can play a useful, influential, and necessary role in extending the reach of healthcare and providing essential services that more fully  meet the needs of patients.

What’s the bottom line?

The secret is out. Medicine is a business and public-private partnerships are the future of a thriving health system. The costs to cover our big, expensive care models have to come from somewhere. Why not balance those costs across industries that share in the gains? Imagine your local CVS was the site of a family and child community center. What if they sponsored a community garden that housed locally grown foods at a discounted price, and offered community programs related to health and wellness? And what if the retail clinic was affiliated with the local medical home, such that patients received the right type of care at the right place, and at a lower cost?

The complex needs of the medical system require integration of various models of service delivery. In the end, every healthcare organization’s bottom line should be the same and it’s not just centered on profits. Innovation requires building social equity while providing cost-effective, patient-centered care. Together, CVS and similar partners may enable our health system to extend its reach to provide the quality, convenient, affordable, and accessible care that is needed across the US.

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