10 Items or Less: Walgreens Takes on Primary Care

You've been able to stop in for years, grab a bag of chips, a Chia Pet, some Flintstone's Chewables and to finally drop off that disposable camera you've had since your vacation to the Poconos a few years ago...but with a new announcement, America's largest prescription retail establishment would like to become your neighborhood doctor's office. That's right, in April 2013, Walgreens made history by announcing they're stepping beyond simple flu shots, vaccinations and blood pressure monitoring and into the arena of primary care.

Though monumental, the decision hardly comes as a surprise, and the move has been in development for a while in the retail chain community. In January, the company announced they'd launch their own take on ACO's and would become "care extenders" that would serve as an arm to implement the health plans drafted by physicians. Therefore, Walgreens primary care initiative is really an extension or "step beyond" this initial development.

Walgreens isn't the only retail chain with thoughts of entering primary care, as made evident by a recently leaked corporate document from Wal-Mart. The document seemingly outlined specific plans to start providing primary care to patients has since been shelved. Walgreens other main competitors, Target and CVS, have also been providing basic levels of care and consultation for chronic illness patients, but only after a diagnosis has been made elsewhere. Essentially, Walgreens leads the charge for retail chains to directly tackle primary care services. It's a decision garnering praise from Tom Charland, chief executive officer of Merchant Medicine, a health care consulting firm, who was quoted in a recent Kaiser Health News article as saying:

"Those two words, diagnosis and treatment, are big words. They show Walgreens is coming out of the closet and saying we really are going to do primary care now."

Walgreens already employs nurse practitioners and physician assistants at more than 300 of their Take Care clinics in 18 states and the District of Columbia to perform tests and make diagnoses for chronic illnesses like diabetes and hypertension. These nurse practitioners and physician assistants will be able to write prescriptions, to refer their patients for additional testing and to further assist them on their road to managing chronic and interruptive medical conditions.

"We're not trying to take over primary care," said Heather Helle, a division Vice President at Walgreens. "We think we can help support physicians and transform the way care is delivered to provide more access points at a time when people need it the most."

Helle also says that primary care physicians will oversee Walgreens clinics, which will transmit their test results, and other medical information, electronically to doctor's offices.

More Access = Better Care?

Walgreens new move has a number of supporters, many of whom see the company's decision as a "progressive" and proactive solution towards the growing physician deficit, while also expanding health care access points for all patients. Retail clinics stake their claim by appealing to consumers by consolidating services, from diagnosis to prescription filling, and offering convenience and savings. According to a 2011 study published in the American Journal of Managed Care, retail clinics offer services up to 30-40% cheaper than those at a doctor's office and 80% less than an Emergency Room visit. While Walgreens main source of revenue is its pharmacy services, and many cynics note that retail pharmacies charge more for generic medications than independent pharmacies, the added value comes in the form of convenience for the customer, as they eliminate a separate trip to the doctor's office and may like the idea of a cheap, ubiquitous source of primary care.

A ThinkProgress article on the development challenges critics of Walgreens, saying they "ignore the needs and realities of U.S. Healthcare." According to the article "increasing reliance on practitioners and physician assistants to provide primary care is absolutely critical to meeting increased patient demand as an increasing number of Americans gain coverage under Obamacare." Since healthcare reform already calls for the expansion of community health clinics and healthcare collaborations in the first place, Walgreens may simply be embracing the change.

Furthermore, the issue of diminishing accessibility to healthcare could be partially addressed by Walgreens' move into primary care. If retail chains can carefully monitor a patient's chronic care needs, the level of patient compliance may increase effect could be considerable. Researchers estimate that non-compliance leads to $300 billion in wasteful health expenditures every year. Some also see the Walgreens development as a godsend to chronic sufferers from disadvantaged backgrounds. Typically, rural and low income populations struggle to get the care they need for a price they can afford. With Walgreens wide footprint in the United States, more health care access points are created.

More Access = Fragmented Care?

As is to be expected, Walgreens expansion leaves many skeptics and critics questioning the motives and intentions of the corporation, and positing the effects it could render on the already fragmenting healthcare system.

The American Academy of Family Physicians president, Jeffrey Cain, dismissed Walgreens primary care initiative as a detriment to all saying that, "it ends up being riskier for patients and costlier for the country." Cain's colleague, Steve Weiberger, also maintained a cautious attitude towards the change. "We need to figure out how the patient can be best served...in terms of safety, access, and communication with the primary care physicians."

On his own blog, Kevin Pho, MD, noted that introducing more primary care physicians into the doctor-patient equation, in addition to the numerous specialists patients already see, can create more divisions, barriers and communication hiccups in the medical landscape.

He illustrates this principle with a hypothetical. A Walgreens physician changes a patient's prescription or medication dosage. When this change is administered, is there any guarantee that the primary care doctor who saw the patient before will also get this information? As it stands, Electronic Medical Records don't necessarily "speak" clearly with each other. Even if Walgreens were to send a fax of this information change to the previous Primary Care doctor, this only adds to the mountains of cumbersome paperwork and documents which over-burdened physicians already have to deal with in their crammed daily schedules.

Another problem which Pho highlights is that of patient-doctor continuity. If a particular patient makes multiple visits to a Walgreens Primary Care facility, there's no guarantee that they'll end up seeing the same provider each time. This can diminish the quality of the care provided, and leads to a less personalized approach to dealing with chronic health conditions. Where routine visits with the same primary care doctor breed familiarity, an open patient-doctor dialogue, and ultimately compliance and effective management and care.

How It'll Shake Out

Those most cynically minded will note that, at the end of the day, Walgreens decision is financially based, since they stand to hit on a lucrative payday with long term management of chronic care, but they shouldn't be vilified as primary care competitors. Pragmatically speaking, Pho doesn't blame primary care itself or even Walgreens for the way things are changing. While the many healthcare policies that have seemingly driven primary care into the "endangered species" list may seem most at fault, it's important to note that drugstores are capitalizing on the primary care shortage in order for fill a specific need. Helping customers who aren't willing to wait around for months to see a doctor, want cheaper care, or simply like the convenience of being diagnosed and filling a prescription at the same place.

As for how patients and primary care will be affected? It still remains to be seen.

References

Appleby, Julie. "KHN: Kaiser Health News." Walgreens Becomes 1st Retail Chain To Diagnose, Treat
Chronic Conditions. KaiserHealthNews.com, 4 Apr. 2013. Web. 15 Apr. 2013.

Mukherjee, Sy. "Why Walgreens' Decision To Provide Primary Care Is A Glimpse Into The Future Of
U.S. Health Care." ThinkProgress RSS. ThinkProgress.org, 4 Apr. 2013. Web. 15 Apr. 2013.

Pho, Kevin, MD. "Walgreens Moves into Primary Care, and It's Our Own Damn Fault." KevinMD.com.

KevinMD.com, 12 Apr. 2013. Web. 15 Apr. 2013.

 

Dylan J. Chadwick

 

Dylan Chadwick is a graduate of Brigham Young University where he earned a Bachelor of arts in English and a minor in Spanish. Though spending his formative years in Cardiff Wales, he came to adolescence in Elizabethtown Kentucky, and considers it his home. He received the Eagle Scout Award, served a voluntary humanitarian mission to inner-city Los Angeles from 2007 to 2009, and once met Alan Alda on a golf course. He's an avid writer who cut his teeth contributing to student papers and continues writing for various print magazines, blogs and web resources. A ravenous fan of baseball, rock music and Dan Aykroyd-era Saturday Night Live, he plans on one day utilizing these interests in a Masters degree in American Studies and Literature. He also maintains a freelance illustration company on the side.