Retail Health Gaining Strength in a Competitive Market

Retail Health Gaining Strength in a Competitive Market

While I usually touch on emerging or existing legislation in my articles, I thought I’d pivot and write about something happening in the healthcare marketplace that has surprisingly little regulation or oversight at all.

That would be the growth of retail health – that is, clinical or healthcare services being offered in the retail setting, such as at clinics in pharmacies, grocery stores, or shopping centers.

Walmart, Walgreens, Amazon, and CVS are all jumping into the game, with significant investment and acquisitions happening in the past year.  

Retail health’s appeal to consumers is that basically, healthcare is provided like any other retail commodity. Retail health clinics offers convenient hours, walk-in or last-minute appointments, less-expensive services, and transparency in pricing. Retail health clinics are mostly staffed with physician assistants and nurse practitioners who in turn are offered regular hours and strong administrative support.

The forecast for retail health in this post-pandemic era is bright and sunny. According to an analysis by Bain & Company, retail health has the potential to grab as much as a third of the U.S. primary-care market by 2030. Indeed, one survey says that about two-thirds of Americans believe that five years from now, most primary-care services will be provided at retail health clinics.

The potential for growth is in one part energized by brand familiarity and loyalty. For example, over 40 percent of Americans shop at Walmart on a weekly basis, and nearly two-thirds of American adults have an active Amazon Prime membership.

Now, while retail health is making a move into primary care, recent action seems to indicate that they also may be using relatively inexpensive primary-care services as a loss leader for them to enter the chronic care arena. CVS recently bought Oak Street, which, yes, is primary care, but it is primary care for the Medicare crowd, whereas reimbursement will be value-based, and 9 out of 10 patients have a chronic condition. CVS has also bought Signify, a home health company.

In order to successfully manage chronic care, a healthcare entity needs to be able to track and communicate with patients, and establish a network of providers for successful continuity of care. Does retail health have that? Maybe not yet, but retail health clinics are digitally connected to the consumer, and they appear to be well-poised to move patients seamlessly between in-person care and virtual care.

Most importantly, retail health can afford to experiment (and maybe fail) with some of those experiments. Why? Because they are well-bankrolled by huge corporations.

As I mentioned, the retail health sector is remarkably unregulated. Most states do not issue facility licenses to retail health clinics, avoiding oversight by state departments of health. Only Massachusetts has regulations designed specifically for retail health; Massachusetts limits the clinics to a specific set of services. And in fact, one service that retail health clinics cannot provide in Massachusetts is primary care.

Stepping back, if we use the language of retail and capitalism, it has become apparent that in the next few years, hospitals and physicians are going to have to compete for a decreasing number of paying customers (that is, for commercially insured patients). More of the population is aging in or becoming eligible for government programs. Utilization of healthcare services is down 6 percent from pre-pandemic levels, while emergency-room visits are down 30 percent – the only increase in usage among healthcare services was in urgent care and hospital outpatient services.

And in this competitive environment, retail health is throwing its hat into the ring. It’s the Walmart-ing of American Healthcare.

Print Friendly, PDF & Email

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

Related Stories

Knowing the Score: MIPS

Knowing the Score: MIPS

EDITOR’S NOTE: Medicare’s legacy quality reporting programs were consolidated and streamlined into the Merit-Based Incentive Payment System, known as “MIPS.”  The Merit-Based Incentive Payment System

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Hospital staff continue to grapple with the complexities of Medicare notices.  In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, will present the latest requirements for preparation and delivery of CMS-mandated forms, including the Advance Beneficiary Notice (ABN), Hospital-Issued Notices of Noncoverage (HINNs), Important Message from Medicare (IMM) and Medicare Outpatient Observation Notice (MOON), and practical solutions through foolproof workflows and compliance auditing.

January 25, 2024
OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

Dive into the complexities of Obstetrics and Gynecology coding, addressing challenges from antepartum to postpartum care. Learn to decode intricate guidelines, tackle claim denials, and safeguard your practice’s financial health. Uncover the secrets to compliant coding, reducing errors, and optimizing reimbursement. With practical exercises and expert insights, this webcast empowers coders, auditors, and healthcare professionals to elevate their OBGYN coding prowess.

February 28, 2024
Unlocking Clinical Documentation Excellence: Empowering CDISs & Coders

Unlocking Clinical Documentation Excellence: How to Engage the Provider

Uncover effective techniques to foster provider understanding of CDI, empower CDISs and coders to customize their queries for enhanced effectiveness, and learn to engage adult learners, leveraging their experiences for superior learning outcomes. Elevate your CDI expertise, leading to fewer coding errors, reduced claim denials, and minimized audit issues.

December 14, 2023
Coding for Spinal Procedures: A 2-Part Webcast Series

Coding for Spinal Procedures: A 2-Part Webcast Series

This exclusive ICD10monitor webcast series will help you acquire the critical knowledge you need to completely and accurately assign ICD-10-PCS and CPT® codes for spinal fusion and other common spinal procedures.

October 26, 2023

Trending News

It’s Heart Month! Use code HEART24 at checkout to receive 20% off your cardiology products. Click here to view our suite of Cardiology products!