American Medical News
By — Posted April 22, 2013
Fading away are the days of retail clinics being used for only stuffy noses and aching ears. Patients soon will be able to go to a Walgreens pharmacy to pick up a box of tissues and come out with a diagnosis for diabetes and a care plan to treat it.
Walgreen Co. announced April 4 that it is expanding services at its 360 Take Care Clinics to include diagnostic and treatment services for common chronic conditions such as diabetes, hypertension and high cholesterol. Although most retail clinic chains have expanded services in recent years to help drive more patient traffic year-round, Walgreens is the first to offer a one-stop shop for diagnosis and treatment for certain chronic diseases.
The company said the move is an effort to address what it sees as access issues many patients are having because of the growing physician shortage, an aging population and an increased prevalence of chronic diseases. It said the 30 million patients expected to gain insurance during the next decade through the Affordable Care Act only will exacerbate the issues.
The announcement comes just months after the Centers for Medicare & Medicaid Services approved Walgreens as the first pharmacy chain to be part of an accountable care organization. It is partnering with physicians and hospitals to form ACOs in Florida, New Jersey and Texas. The company's goal is to support and complement traditional health care settings regardless of an ACO relationship, said Jeffrey Kang, MD, MPH, Walgreens senior vice president of health and wellness services and solutions, in an email.
“In our ACO relationships, all of Walgreens clinical services, including those provided at Take Care Clinics, form a total population health solution for our physician or health system partners that can help improve outcomes, access and convenience, while lowering health care costs,” he said.
“Our convenient locations, hours of operations and expanded scope of services help the physicians and health systems bridge gaps in patient care and help to achieve the 'triple aim,' ” he said, referring to improved outcomes, higher quality of care and reduced costs.
In the context of an ACO, where there is a fully integrated care delivery system in place that includes primary care and good electronic communication among all parties, “there's potential for Walgreens to be able to help improve someone's health care,” said Jeffrey Cain, MD, a family physician in Denver and president of the American Academy of Family Physicians. But if the clinics are acting as stand-alone pieces, “there is the real potential to further fragment an already fragmented American health care system,” he said.
Dr. Kang said Walgreens and Take Care are committed to facilitating continuity of care, and that the goal is not to replace primary care physicians but to complement the care they give. The clinics “will strive to communicate pertinent clinical information with a patient's primary care provider by sharing a comprehensive patient visit summary,” he said.
CVS' MinuteClinic chain, the nation's largest with about 620 locations, also has made efforts to expand its primary care service offerings by adding chronic disease monitoring. It plans “gradually” to increase chronic disease management services, said Andrew Sussman, MD, president of MinuteClinic and senior vice president and associate chief medical officer for CVS Caremark.
Dr. Sussman, who did not say whether the company plans to add disease diagnosis, said the expansion of chronic disease services always will be in coordination with a physician-led medical home. “This could be in collaboration with the patient's existing primary care provider, a new primary care provider that we help identify, or in coordination with physicians at one of our 26 health system affiliations nationwide.” He said about 50% of MinuteClinic patients do not have a medical home.
Dr. Cain said he is concerned that as retail clinics expand their primary care offerings, some patients may come to rely on them and make no effort to find a medical home. He likens it to fast food.
“A lot of people use fast food as part of their diet, but if they base their entire diet on fast food, that's ultimately unhealthy for them. And if we are basing health care for our people on retail clinic, episodic, non-integrated health care, then that's ultimately not as good for our patients.”