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01/18/2022

Breaking down barriers: Retail pharmacy is becoming a force in an unexpected area — providing mental health services

The rewards accrued from offering mental health services can be substantial in terms of clinical outcomes, customer satisfaction and retention, and improved revenue.
Sandra Levy
Senior Editor
Sandra Levy profile picture

Although the pandemic has taken a vast psychological toll on most Americans, one silver lining is that it jump-started conversations about mental health, and it’s helping to lift the stigma that has long been a barrier around people seeking professional help. The pandemic also has been a game changer for many retailers, who are becoming a tour de force in an unexpected area: providing mental health services. 

Retail pharmacy’s foray into mental health services comes at a time when there is an increased need for them.

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Nurse Practitioner and patient
Kroger says it saw the need for mental health services prior to the pandemic because of the scarcity of resources throughout the country.

The rewards accrued from offering mental health services can be substantial in terms of clinical outcomes, not to mention customer satisfaction and retention, and improved revenue. Prime standouts that are making headway in the mental health space include Kroger, CVS Health and Walgreens. 

Kroger began providing mental health services six years ago via The Little Clinic. These services are currently offered to patients in nine states where the clinic operates. 

Marc Watkins, Kroger chief medical officer, said that while the need for mental health services was accelerated by the pandemic, Kroger saw the need for these services prior to the health crisis because of the scarcity of mental health resources throughout the country. 

[Related: Care and convenience: Supermarket pharmacies cement themselves as health destinations]

“We also noted that behavioral health has to be more accessible,” Watkins said. “That was evident six, 10 and 20 years ago, and mental health continues to be under-treated. One in five Americans will have a mental health issue in their lifetime. Depression, anxiety, stress and insomnia can all be part of a larger mental health issue.”

Aside from responding to an unmet need, Kroger said it believed that its nurse practitioners were capable of providing these services. “We needed to bring our NPs up to the top of their licenses,” Watkins said.

To that end, Kroger deployed specialized training tools for its NPs and PAs so that they could accurately assess patients and prescribe the proper therapies, and it created clinical-based resources to guide them through the process. “They are able to evaluate anxiety, depression and stress on a firsthand basis in our clinics,” Watkins said.

"Depression, anxiety, stress and insomnia can all be part of a larger mental health issue."
Marc Watkins, chief medical officer, Kroger Health

CVS Health began providing mental health services in January 2021 via its MinuteClinics and HealthHubs, where licensed social workers offer mental health screenings and counseling services to patients with mild to moderate behavioral health needs. 

“We saw the need and the importance of offering this service. Fifty-one million people have a diagnosed mental health issue or illness,” said Cara McNulty, president of behavioral health at Aetna, a CVS Health company. “Everyone will have some kind of mental health disruption. Not everyone will have an illness, but we’re going to have stress, resiliency issues, situational anxiety, low-level depression or ‘the blues.’”

McNulty also noted that there are 24 million people in need of alcohol care and substance use disorder treatment. “There’s an abundant need for the industry to think differently about how we talk about mental health, how we deliver care, how we meet people in their community and how we make it easy for people to get that care,” she said.

CVS Health offers mental health services in 30 locations in Houston, Philadelphia, New Jersey and Tampa, Fla. 

[Related: Walgreens Boots Alliance highlights expanding mental health resources]

As retailers provide services to patients with mental health issues, they also are finding that collaborations with partners are crucial.

A prime example is Walgreens. In 2016, Walgreens launched a digital platform, via online and mobile, to provide free 24/7 access to mental health screenings through a partnership with Mental Health America. The platform also helps to connect people with local resources in their community via Mental Health America affiliates.

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A pharmacist and NP at The Little Clinic
Kroger, which began offering mental health services six years ago, provides critical help for patients through The Little Clinic.

Additionally, Walgreens Find Care, an expanded digital health platform, gives customers access to a range of providers, including mental health care, and Walgreens has expanded the range of providers offering mental health services via the platform. Through Walgreens Find Care, customers can access mental health services nationally through providers like Sanvello and BetterHelp. Many of the local and national healthcare systems listed on its digital health platform offer mental health care. 

“We believe we can play an important but also a very specific role as part of patients’ care teams when it comes to mental health,” said Rick Gates, Walgreens senior vice president of pharmacy. “That’s why many of our current solutions and services are partnership-driven, with the appropriate clinical experts helping to treat and care for those with needs related to mental health. Through our partnerships, we also work to ensure better care coordination among providers, including our pharmacists.”

Walgreens also is improving access through its collaboration and coordinated care model with VillageMD. At Village Medical locations, mental health services are provided by social workers.

Going Virtual
Beyond partnerships and collaboration, offering virtual access to care is yet another crucial responsibility for retailers in the mental health arena.

[Related: Retailer of the Year 2021: Walgreens seizes its omnichannel opportunity]

Kroger is gearing up its telehealth services for patients. 

“When the country shut down around March 17, we had just dipped our toes into telehealth to get our nutritionists up and running in three locations,” said Meggen Brown, chief nursing officer and national health and wellness clinical director at Kroger Health/The Little Clinic.  

Today, 219 locations in nine states offer telehealth services, including mental health services. “We’re going to expand that,” Brown said. “We are in talks with a few other companies to help us so we don’t stand alone on this platform.”

“We’re using technology to make it easy for people. We share tools and resources as part of the care plan.”
Cara McNulty, president of behavioral health at Aetna

CVS Health also offers a virtual mental health option in which a licensed clinical social worker provides an assessment and diagnosis. “Coming in to see that licensed clinical social worker or seeing them virtually is about normalizing this conversation and checking in on how you’re doing and getting the care and support you need,” McNulty said. “We’re using technology to make it easy for people. We share tools and resources as part of the care plan.” 

Walgreens also is taking this responsibility of caring for patients virtually to new heights. VillageMD has likewise moved many of its social work services to telehealth, such as screenings and assessments. “Many people are unaware that mental health services are delivered through primary care, and VillageMD is working to eliminate barriers to mental health through our services at Village Medical at Walgreens and via telehealth,” said Clive Fields, chief medical officer at VillageMD.

The Right Players
The ability to refer patients to partners when they need a higher level of care is another hallmark of successful retailers in the mental health space. 

One only has to look at Kroger. The retailer elevates patients to its health system partners, academic medical centers and community-based resources, with an effort on making the transition smooth and seamless. 

[Related: Walgreens, Mental Health America team up on mental health support]

“We want to have a white glove handoff so we help facilitate the appointment, and we also share records when appropriate,” Watkins said. “Most patients follow up and they end up having that relationship with our NP or PA. Then they’re able to get that warm handoff. That makes it easier for the accepting provider so they’re not starting from scratch.” 

Kroger also has a dedicated access line to its health systems partners, and the retailer makes appointments for patients “so these patients are not left to the wild, and not fending for themselves,” Watkins said.  

“We’re part of that augmentation of care,” Brown said. “We are part of a care quality platform where we can share medical records. There are a lot of suitcase communities. Sometimes we’re the first touchpoint.” 

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CVS Minute Clinic
CVS Health began providing mental health services in January 2021 via its MinuteClinics and HealthHubs, where licensed social workers offer mental health screenings and counseling services to patients with mild to moderate behavioral health needs.

CVS Health also has plans in place for patients who need a higher level of care. 

“We have set up a triage and partnership service to make sure people get to the right level of care,” McNulty said. “We created around our HealthHubs partnerships with higher level care practices so that licensed clinical social workers will work with that partner and get that person scheduled to see, for example, a psychiatrist so the person isn’t navigating this themselves. After a patient sees a psychiatrist, they often send the patient back to a MinuteClinic or HealthHub to continue their therapy with the social worker.”

Walgreens also is focusing on connecting people with clinical resources through its own properties. “With many barriers and challenges facing both patients and our mental health and healthcare system, the Walgreens platform has aimed to help meet the growing need for resources and access to care,” Gates said. “Ultimately, the goal is improved health outcomes through early screening and intervention, and through strategic partnerships, to help connect more people with clinical resources in their community who can help.”  

[Related: CVS Health supports tornado recovery, relief efforts]

Utilizing pharmacists as a way to help patients deal with mental health issues, also is critical to success in the mental health arena.  

McNulty indicated that when a patient picks up a prescription for a mental health issue, CVS pharmacists make the patient aware that mental health services are available at that location, or  when a patient picks up a medication for a sinus infection and shares with the pharmacist that they’ve been struggling, the pharmacist will inform them that depression screenings are available at CVS Health’s MinuteClinics. 

“The pharmacist, the MinuteClinic clinicians, our concierge support services in our HealthHubs and licensed clinical social workers all coordinate and work together. It’s one care team keeping the consumer at the center of that health equation,” McNulty said, noting that when patients have a new diagnosis, such as depression, better outcomes and longer adherence are achieved when their medication is matched with therapy. 

Kroger also is a front-runner in involving its pharmacists in the mental health space. “Our pharmacists do comprehensive medication reviews on all of their patients, looking at behavioral health drugs, as well as other medications patients are taking to ensure there are no side effects,” Watkins said. “If they see a potential negative interaction between a medication, they alert us, the prescribers, the health systems or community-based providers.”

Brown said that many times the patients disclose to Kroger’s pharmacists that they have mental health problems and these pharmacists refer these patients to The Little Clinic.

Walgreens is not standing on the sidelines when it comes to utilizing pharmacists to care for patients with mental health issues. Walgreens formed a unique collaboration with the National Council for Mental Well-being and the American Pharmacists Association in 2019 to provide Mental Health First Aid training for Walgreens’ pharmacists and team members within its HR department. The training includes understanding risk factors and warning signs for mental health and addiction concerns and strategies for how to help someone in both crisis and noncrisis situations. 

In October, Walgreens spearheaded efforts to make the training available for all of its pharmacists, in further recognition of the important role pharmacists can play as accessible healthcare providers in the community, Gates noted. 

[Related: New publication for convenient care clinicians to launch in 2022]

He also pointed out that medication adherence can also be a barrier for many with mental health conditions. “Given our pharmacists’ role as medication experts, and some of the other programs we have to help patients stay adherent to their medication regimens, this is also an area of opportunity to help achieve better outcomes,” Gates said.

People who experience anxiety or depression may not know how to start their journey or who they should see, or may not be able to be seen right away by a mental health professional. Retailers are helping on this front too.

“One of the things we know is that people often don’t know that what they’re experiencing can be helped or it’s totally normal,” McNulty said. “They don’t need to be the one diagnosing it. Someone may say ‘I don’t feel good.’ The clinical social worker does the assessment and diagnosis and then provides treatment for that individual. The patients say, ‘I didn’t have to do all the heavy lifting. You made it easy for me to come in and talk to a social worker, have an assessment, help me understand and normalize what’s happening, and either see that therapist or get me to the right level of care.’”

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Nurse practitioner treating young woman
At The Little Clinic, most patients end up having a relationship with their NP or PA.

Walgreens also focuses on helping people get started on the journey of seeking care. “With the COVID-19 pandemic, stay-at-home orders, work from home, social distancing, home schooling, stress and other restrictions have had large impacts on those who are seeking mental health assistance,” Gates said. “As an accessible healthcare provider, our ability to help consumers understand where to start or how to get support is critical.” 

Combating Stigma
Despite all of their efforts to excel at clinical services and referrals, the stigma around seeking help for mental health is a challenge. Retailers are rising to the occasion.

Calling out the stigma of mental health is something that Kroger also is passionate about. “We really try to bash down this stigma associated with mental healthcare delivery and share the fact that in our healthcare setting, all of the patient’s information is privileged,” Watkins said. “It cannot be shared with anyone else, including employers, unless patients give permission.”

Kroger recently hosted a virtual event, The Wellness Experience with singer-songwriter Jewel. The virtual wellness platform and multiday festival experience provided free healthy living resources to help customers take actionable steps. “This event is one example of showcasing and making mental health treatment part of the conversation and the narrative. The narrative has to be that it’s OK to address your mental health just like you would your physical health,” Watkins said.

[Related: How a holistic approach to wellness is driving innovation]

In October, Kroger held its second annual World Mental Health Day summit and concert, which also featured Jewel, as well as Cheryl Burke and Olympic gold medalist Lori Fernandez, who talked about their mental health struggles.

Kroger also sends a quarterly newsletter to customers, providing advice on how to deal with stress, what foods work best to help reduce stress and when to begin to seek care and counseling. The company also promotes mental health awareness on social media.  

CVS Health also is pulling out the stops to lift the stigma, with radio ads where the services are being offered and in-store signage. “It’s all about normalizing the conversation and making it easy for people to say, ‘I haven’t been feeling great,’ and making it super easy to seek that care,” McNulty said. 

CVS Heath also informs primary care providers about their mental health services. “Often primary care providers want people to go for therapy but they don’t know where to send them because they don’t know who accepts their insurance,” McNulty said. “Because we’re payer agnostic, it’s easy for a primary care provider to refer someone to CVS for this service.”

Walgreens’ Gates said that while mental health has really become a part of the national dialogue since the onset of the pandemic, stigma is still a barrier to many people seeking treatment or care. “Helping to reduce stigma is part of our objectives as well,” he said.  

What the Future Holds
What does the future hold for retailers in the mental health space? 

It appears that given many of the positive outcomes that are being achieved, retailers will expand their mental health services. 

“We will be adding additional sites throughout next year because we’re seeing such positive outcomes,” said McNulty, who noted that when patients have a new diagnosis, such as depression, better outcomes and longer adherence are achieved when their medication is matched with therapy. “The patient wins,” she said. 

[Related: NACDS, Johns Hopkins report: Pharmacies play a vital role in achieving health equity]

Gates said Walgreens continues to receive positive feedback regarding the steps the retailer has taken to help meet the growing need and demand for mental health resources both from customers/patients, healthcare partners and those within the mental health community.

In October 2021, Walgreens announced plans to open 1,000 Village Medical at Walgreens locations by 2027. “We plan to continue adding more social workers as the demand increases,” Fields said.  

Watkins envisions Kroger will continue to look for ways to serve its communities better and “understanding that mental health is one of those aspects. We are providing services today through our NPs, pharmacists and dietitians. As we continue to evolve, you’ll find that nothing is off the table, including hiring psychiatrists and psychologists.”

Perhaps Brown summed up the benefits for retailers and patients best when she reflected on a patient who was thankful for the mental health services that Kroger provided: “We listened to them and got them the help they needed, but also on that journey we were able to pull in the food piece. Now this person only wants to go see that one pharmacist, that NP and this dietitian because we were able to support them fully. We’re looking at the whole health and wellness of somebody, not just the mental health part,” she said.

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