While companies like Walmart and Walgreens once had stars in their eyes and believed they could “fix” healthcare, last year we saw retail giants rapidly jumping ship from the primary care business after investing billions and concluding that “healthcare isn’t a sustainable business model.” Retail healthcare might be convenient, but a meaningful primary care experience can’t be replicated in a store.
What’s missing from the equation for retail health today is that incentives, including contracting and cost trends guarantees, are not clearly aligned for key stakeholders. While retailers intended to provide consumers with quick and easy access to primary care in stores, financial incentives and operational costs were not value-aligned. In contrast, the whole premise of a value-based care model makes sure that providers, employers and members all stay engaged with care, and that all stakeholders are aligned on improving outcomes for the member.
Retailers may have fallen short in their foray into healthcare, but there are lessons we can take away about where and how primary care innovation has succeeded, how to replicate and scale across the US, and how to engage with members and drive them to the right type of care before they become more sick and expensive for the health ecosystem.
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Where retail health giants went wrong
Primary care has been proven to play a key role in helping drive down healthcare costs. The U.S. could save $67 billion in health costs if every American used a primary care physician as their go-to source of care.
The challenge is that the traditional model of primary care is broken and faces a major accessibility problem. Access to quality care isn’t always easy to come by, with appointments often booked out for months. On top of this, primary care often leads to a fragmented care experience, where coordination and referrals to specialists aren’t always seamless and primary care providers (PCPs) aren’t kept in the loop on how care is progressing. This results in a healthcare system that often takes a reactive, versus proactive, approach to care.
Additionally, reimbursement generally continues to be low for independent PCPs. Some primary care organizations seek to attach to health systems for higher reimbursement, but that in turn can drive up costs. The largest element of cost is staffing, and more medical students are choosing specialty fields over primary care because of higher compensation, and often primary care clinics operate on a fee-for-service basis that prioritizes patient volume in order to recoup the costs. This creates an unsustainable workload, which leads to physician burnout, causing providers leaving the field altogether, contributing to the provider shortage.
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Today’s patients need holistic care from a familiar doctor, not a transactional experience where they’re buying groceries after going in for an annual physical. A truly meaningful PCP experience isn’t just convenient. Relying on convenience causes many large retail companies to rely on being able to see a high number of patients in order to be profitable. While there’s an urgency to reimagine what primary care looks like, what’s missing from the equation for retail health today is that incentives between the patient, supplier, and care team are not clearly aligned for key stakeholders.
Where and why primary care has been successful
When primary care is most successful, patients are able to receive holistic care from a provider who understands their health needs and has built an ongoing relationship with them over time. Primary care needs to address the majority of a patient’s needs and serve as the first stop in a patient’s health journey for basic well and sick care, and for questions about more specialized care. It also needs to serve as one place for labs, first line medications, and point of care tests to screen for early detection. Patients shouldn’t only visit their PCP to treat the occasional ear infection or common cold – their PCP should also know when patients are overdue for annual cancer screenings, to take a proactive (versus reactive) approach to addressing small health concerns before they become larger issues or chronic diseases.
“Band-aid” solutions to primary care have not been enough to fix the larger issues that primary care in the US is struggling with today. The healthcare industry at large needs to shift to an advanced primary care (APC) model to improve health outcomes and reduce the total cost of care.
To make the shift, purchasers of healthcare need to adopt a value-based care model where providers are rewarded for delivering high-quality care and improved health outcomes at the lowest possible cost. It ensures that providers, employers and members all stay engaged by prioritizing patient outcomes and high-quality care over volume of patients seen.
With advanced primary care (APC), patients receive expanded and more timely access to care. They are able to make same or next-day appointments, and have the freedom to visit their primary care team as many times as they need without being restricted by cost concerns. APC also allows patients more time to spend with their providers, because visits are structured to allow providers to care for all aspects of their patients’ health.
Part of what makes APC successful is its emphasis on deepening patient engagement. Health navigation and advocacy are two central components of APC. While PCPs remain the primary point of contact for addressing a patient’s health concerns, other members of a care team – including health coaches, behavioral health clinicians, and nutritionists – can play a critical role in supporting patients with lifestyle changes discussed during their primary care visits. For example, after patients are seen by a PCP, care teams can help follow up with the patient to reinforce directions from the provider or educate the patient on various health conditions they may be managing. Care teams can also help steer patients toward the best care options via navigation and personalization that make the most sense for the patient’s needs while avoiding high-cost venues.
Large employers like JPMorgan Chase are beginning to partner with healthcare organizations to offer advanced primary care onsite to employees. Partnerships like these make care much more accessible and convenient, while also ensuring each patient has a personalized care experience tailored to their health needs, resulting in a better patient care experience.
The primary care problem in the US needs to be addressed. While we continue to see large retailers exit the primary care space, there are many lessons we can take away from their investment in care clinics. A true primary care experience needs to be designed in a way that encourages patients to have regular access to the same provider, allowing them to build a relationship over time with a provider who understands their health needs. Financial incentives must also be clearly aligned for stakeholders, to ensure that clinics aren’t overburdened by an unsustainable number of patients coming in and out.
Primary care is the backbone of the U.S. healthcare system, and it’s time we reimagine how patients are seen by and interact with their PCPs. Although retail health clinics weren’t the answer, newer models for primary care are emerging and have been proven to be successful that produce better outcomes for patients, lower costs for members, and allow PCPs to engage with patients more frequently.
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Kevin Wang is Chief Medical Officer at apree health, leading the Quality, Provider, Managed Care, and Product Development teams. Central to Kevin’s role is enhancing the organization’s clinical capabilities to improve quality, patient outcomes, patient satisfaction, and care team satisfaction in arrangements with increasing outcomes-based risk.
Kevin previously worked at HealthCare Partners/DaVita Medical Group, Evolent Health, and Huron Consulting Group where he successfully designed and implemented population health clinical interventions across diverse healthcare landscapes including health plans, academic medical centers, employer-based care centers, integrated delivery systems, large physician groups, and independent community hospitals. Kevin’s training was in the New York-Presbyterian Healthcare System, an affiliate of the Weill Medical College of Cornell University. Kevin holds a B.S. in Biochemistry and Molecular Biology from the University of Maryland Baltimore County and a Doctor of Medicine (M.D.) from New York Medical College.
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