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Retail clinics to play larger role for seniors.

A new partnership between the federal government and some of the nation's largest pharmacy chains could help propel more Medicare beneficiaries into retail clinics for services traditionally provided by primary care physicians.

The Centers for Medicare and Medicaid Services soon will partner with CVS Caremark, Walgreens, Thrifty White, Walmart, and Sam's Club to provide Medicare beneficiaries educational materials on the Medicare Wellness Visit and other preventive services, as well as on the doughnut hole associated with Medicare Part D prescription drug coverage.

In announcing the partnerships, Health and Human Services Secretary Kathleen Sebelius praised CVS for its efforts so far, and added, "we know that pharmacies are among our most effective messengers when it comes to reaching seniors with health information.

"Empowering [pharmacies] to educate people with media about the [Affordable Care Act's] new benefits will help ensure that no senior goes without critical screening or medicines because they don't realize the savings that are now available to them," she said during a press briefing.

Both CVS and Walgreens have said that they plan to more aggressively court seniors to come to their clinics for their health care needs.

Shifting Retail Clinic Demographic

The increased focus on older patients is part of a trend, according to Dr. Ateev Mehrotra and Judith Lave, Ph.D., of the University of Pittsburgh. Their recent survey published in the journal Health Affairs found almost 6 million visits to retail clinics in 2009, a fourfold increase from 2007 (Health Aff. [Millwood]. 2012;31:2123-9). That represents about $460 million in health care spending, according to the investigators.

Their survey also found that more patients are now going to clinics for preventive care, especially the flu vaccine, and increasingly those patients are older than age 65 years.

In an earlier study, Dr. Mehrotra and Dr. Lave found that in 2000-2006, the most common retail clinic patient was a young adult without a primary care physician who sought care for an acute illness such as an upper respiratory tract infection. At that time, 78% of visits were for acute care, whereas 22% were for preventive care.

In the later study period (2007-2009), 51% of visits were for acute care and 48% were for preventive care, largely flu shots.

In the earlier period, children made up 27% of patients, whereas seniors (those older than age 65) accounted for 7%. By 2007-2009, children had declined to 22% of patients and seniors made up 15% of the patient population.

Retail clinics are becoming more popular for several reasons, the investigators said. One is the growing number of locations. Since the earlier study, the number of clinics has grown from about 300 to about 1,200. The three largest retailers are CVS' MinuteClinic, Walgreens' Take Care, and the Little Clinic (which was bought by Kroger in 2010); in all, 24 companies run retail clinics around the country.

Peak visits are in October and November, and are primarily driven by the flu vaccine. Almost half of the visits occurred on nights and weekends, when physician offices were likely to be closed. The clinics are in convenient locations, have price transparency, and can be a low-cost alternative for the uninsured or people with high-deductible health plans, according to the investigators.

"The rapid growth of retail clinics makes it clear that they are meeting patients' needs," Dr. Mehrotra and Dr. Lave wrote. Meeting those needs will become more crucial as the Affordable Care Act drives patients - and the health system - to a primary care-driven model.

Big Chains Hope to Capitalize

The big chains are maneuvering to keep meeting those needs. Walgreens, for instance, is already offering the Welcome to Medicare visit and the annual Wellness visit at its more than 360 Take Care Clinics.

CVS, which has 7,300 pharmacies and 600 Minute Clinics, has distributed 750,000 brochures on Medicare's preventive benefits and the Part D doughnut hole, and has given patients some 30 million receipts imprinted with similar information, Helena Foulkes, executive vice president for CVS Caremark, said during the press briefing.

She noted that the chain has been informing Medicare beneficiaries when they enter the doughnut hole and become eligible for a 50% discount on brand-name drugs. Research has also shown that when drugs cost more, people are less likely to continue taking needed medications, Ms. Foulkes said in an interview.

One study that CVS Caremark conducted with Brigham & Women's Hospital in Boston found that beneficiaries who had to pay the full cost of brand-name medications when they hit the doughnut hole were twice as likely to stop taking them altogether than to switch to generics.

Going forward, CVS Caremark is likely to provide even more services, Ms. Foulkes said. The company has a lot of employers and health plans as clients through its Caremark pharmacy benefit management company. Some have expressed interest in having MinuteClinics offer chronic disease management for their workers and enrollees.

And, CVS Caremark is also talking with the CMS about the role of pharmacies in accountable care organizations.

Ms. Foulkes added that the companies' efforts will continue regardless of whether the ACA remains the law of the land. "We see a future where everyone's trying to figure out how to bend the cost curve and people see us as providing solutions," she said.
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Author:Ault, Alicia
Publication:Internal Medicine News
Date:Sep 15, 2012
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