Crossing the 'retailization' threshold

The U.S. healthcare system's steady migration beyond the exclusive terrain of the physician practices, professional clinics and hospitals — and into the far more accessible and more cost-conscious world of retail pharmacy and health — continues to accelerate. The shift is dramatically expanding access to health services for millions of patients — many of them uninsured or underinsured — and elevating the status of retail clinicians and community pharmacists.

Insurers and health-plan payers, desperate to scrounge up new ways to cut skyrocketing health costs for their members, are eagerly encouraging the healthcare "retailization" trend. Patients are, too. Tens of millions of Americans now embrace the convenience of walking into an in-store clinic or pharmacy, sans appointment, for treatment of their minor emergencies or ailments by a nurse practitioner or the advice and preventive care of a pharmacist.

Among the big insurers now driving the trend: Independence Blue Cross of Pennsylvania, which last week announced that it has expanded its members' access to care by adding coverage for treatment at urgent care centers and retail clinics. The plan even rolled out a new online tool to help its members locate the nearest retail clinic.

IBC CEO and president Daniel Hilferty is fully cognizant of the benefits that come with the expanded treatment option, both for patients and for Blue Cross. For members, coverage of visits to retail clinics and urgent care centers expands access to care "so members can get care when they need it the most, along with the tools and information to make wise healthcare decisions.” It also helps keep those members out of “busy, more costly emergency rooms," he said, saving the insurer big bucks.

It's a tangible benefit. As Drug Store News senior editor Antoinette Alexander points out, nearly 1-in-5 visits to hospital emergency departments in this country "could potentially be treated at retail based health clinics or urgent care centers for an estimated savings to consumers of $4.4 billion," according to a 2010 study from the RAND Corp.

I think those estimates are conservative. Why? Because, like pharmacists, the nurse practitioners and physicians' assistants who staff those retail clinics have heretofore been constrained in the scope of services they can offer in most states. That's changing as more and more states, such as Massachusetts — and more and more payers and other healthcare stakeholders — recognize the need for cost-saving alternatives to ERs and doctor's offices for routine care, and as both pharmacists and retail clinicians are given the tools and regulatory clearance to begin practicing "at the top of their profession," to quote one pharmacy leader at Walgreens.

How far pharmacy and the retail clinic industry can evolve and gain stature among the professional care pantheon is anybody's guess, but a lot will depend on pharmacy benefit managers, payers and insurers, such as Blue Cross. What’s your take on it? Click on the link below to share your thoughts.