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Retail pharmacies address challenges around health equity

The pandemic shone a spotlight on the value of community-based pharmacy in reaching underserved communities.
Mark Hamstra

Retail pharmacies have long sought to address the challenges around health equity in the United States, but their efforts have gained more traction—and visibility—in the last few years.

The pandemic helped bring many of the health system’s inequities to light, as underserved communities were disproportionately impacted, Jim Kirby, chief commercial officer at the Kroger Health division of Kroger Co., told Drug Store News.

“The COVID-19 pandemic brought needed attention to issues that have been impacting communities for years, including the urgent need to improve access to nutritious foods and to provide healthcare to vulnerable populations and underserved communities,” he said.

In the wake of the pandemic, mental health services, patient education, medication adherence and pharmacy access have emerged as key areas of focus for retail pharmacies. They are increasingly partnering with community organizations to address these issues and taking steps to promote systemic changes that address disparities in healthcare.

Research from consulting firm Deloitte has found that healthcare inequities add about $320 billion a year to health care spending.

“If left unaddressed, our actuaries predict the cost of health inequities will top $1 trillion by 2040,” Deloitte said in a recent blog post.

[Read more: Kroger enters clinical trial business]

Racial disparity in particular has an inordinate impact on pharmaceutical care, according to Deloitte.

For example, financial or health insurance barriers delay or prevent Black patients from obtaining prescription drugs 70% of the time, vs. 55% of the time for white patients, the firm said, citing research from the 2019 National Healthcare Quality and Disparities Report, Agency for Healthcare Research and Quality, published in June 2021.

In addition, lack of access to pharmacies in some low-income areas can cause lower levels of prescription drug adherence among Black and Hispanic patients, Deloitte said, citing research from the Los Angeles market published in the Journal of Racial and Ethnic Health Disparities in 2020.

Patients in these areas also tend to speak English as a second language, often do not own a vehicle, live below the federal poverty line and lack health insurance, Deloitte reported.

Similarly LGBTQ+ patients also tend to have negative health care experiences, according to Deloitte.

“Every organization should plan to address health inequities by designing and enabling the future of health care around people and equity,” the research firm concluded. “Health care incumbents, industry disruptors, community organizations, and government agencies each have a role to play in removing the barriers that lead to health inequities and turning unaffordable costs into opportunities.”

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“No one person, organization or entity can advance health equity alone. The private sector, employers, government, hospitals, academic organizations⁠—everyone has a role to play.”
— Dr. Joneigh Khaldun, VP and chief health equity officer, CVS Health

Health Equity Spans Whole CVS Organization

Dr. Joneigh Khaldun, VP and chief health equity officer, CVS Health, said the company has a longstanding commitment to advance health equity.

“To us, health equity is not a series of programs—it’s how we do business,” she said in an interview with Drug Store News. “We leverage our capabilities and reach to create meaningful change as part of our cross-enterprise efforts to advance health equity.”

The company’s CVS Pharmacy division seeks to address barriers to care by providing the communities it serves with increased access to products and services that are affordable and convenient, Khaldun said. For example, to overcome barriers to equitable menstrual care, CVS reduced the price of store brand period products by 25%, absorbed the so-called “menstrual tax”—the sales tax some states levy on menstrual products—in 12 states and partnered with national organizations working to eliminate the tax altogether in 26 states.

The CVS Health division, meanwhile, continues to expand access to mental health services. It offers depression screenings in more than 1,000 MinuteClinic locations nationwide. In select MinuteClinic locations, consumers can access in-person and virtual mental health services, including cognitive behavioral therapy. Project Health, the company’s series of free health screening programs, has expanded to offer free depression screenings at all of its events this year.

[Read more: Watch DSN: CVS Health's Community Equity Alliance addresses health care disparities]

The CVS Caremark division, meanwhile, invests in programs that address barriers to care to alleviate inequities for historically marginalized communities, Khaldun said. The division is focused on three conditions that disproportionately affect people of color: sickle cell disease, HIV and heart disease.

The CVS health equity initiative focuses on three areas, Khaldun said:

  • Empowering employees: “We are empowering our colleagues by providing robust training and learning opportunities to accelerate our ability to help every customer, member and patient we serve achieve optimal health,” she said.
  • Measurement: CVS is standardizing and improving its collection of data related to race, ethnicity, language, sex, gender identity, sexual orientation and disability for its consumers, members, patients and providers, Khaldun said.
  • Taking bold actions: “We are implementing evidence-based strategies and creating collaborations to address some of the most pressing public health challenges in the country, with an initial focus on heart health, mental health and women’s health,” she said.

“By using data analytics to identify inequities and taking action to address them, we strive to improve health care access and quality of health for every population we serve,” said Khaldun. CVS also recognizes the power of collaboration, she said.

“No one person, organization or entity can advance health equity alone,” said Khaldun. “The private sector, employers, government, hospitals, academic organizations—everyone has a role to play.”

Earlier this year, CVS launched the CVS Health Community Equity Alliance, which brings academic and health care institutions together to help expand the community health worker workforce and address health inequities in heart health and mental health, she said.

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“By establishing a clinical trial site network, Kroger Health is utilizing its established, wide-reaching impact on local insights and trends to address major issues facing clinical trial success: difficulty in meeting enrollment targets, patient retention in trials, and an ongoing lack of diversity in patient populations.” ⁠
— Jim Kirby, chief commercial officer, Kroger Health

Kroger Takes Multifaceted Approach

Kroger is also among the retailers taking a multifaceted approach to combatting inequities in health care.

“With 90% of the U.S. population living within five miles of a pharmacy, and 51% of all Kroger stores located in socially vulnerable areas, Kroger Health and The Little Clinic aim to provide all communities with access to healthcare,” said Kirby. “It’s as simple as this: Access to healthcare is no further than your neighborhood retailer.”

Kroger’s massive national footprint as a food-and-drug retailer, with 24,000 healthcare professionals, positions the company “at the nexus of food and pharmacy,” he said. That positions Kroger to be able to improve outcomes through simplified health, wellness and nutrition solutions and increase accessibility to healthcare services, he said.

“Most nutrition insecurity problems are related to social determinants of health, which are conditions in the environments where people live, learn, work and play that affect a wide range of health risks and outcomes,” said Kirby. “Through Kroger stores, communities have access to healthy foods, and through Kroger Health’s services and our Little Clinic locations, people have access to expert, credible and convenient healthcare services.”

He also noted that Kroger has expanded its e-commerce services through Kroger Delivery to reach more customers in underserved areas with fresh, affordable food. In addition, families who rely on the federal Supplemental Nutrition Assistance Program can also utilize this service, Kirby said. Access to healthy food and resources improves health outcomes and may lead to lower risk for developing chronic diseases, he said.

Meanwhile, Kroger’s The Little Clinic locations provide communities with access to quality, affordable care, Kirby said. The company provides a “completely transparent view” into the costs of the health services it provides, he said, which helps patients understand what their services will cost, regardless of their insurance coverage.

Additionally, during the pandemic, Kroger’s Little Clinic locations and Kroger pharmacies administered 11.4 million COVID-19 vaccines.

“Through thoughtful connections and deepened community support, customers became familiar with our company’s healthcare services,” said Kirby.

Kroger also began to offer telehealth virtual visits, which allow patients to talk with a healthcare provider via video calls. This is improving access to nutrition counseling and overall health management in areas where the nearest healthcare providers may be difficult to reach, Kirby said.

Additionally, Kroger Health recently entered the clinical trial space, which Kirby said will create more opportunities for equitable access to clinical trials for historically underserved communities.

“By establishing a clinical trial site network, Kroger Health is utilizing its established, wide-reaching impact on local insights and trends to address major issues facing clinical trial success: difficulty in meeting enrollment targets, patient retention in trials and an ongoing lack of diversity in patient populations,” he said.

Walgreens Pilots Community Programs

Like Kroger and other drug store operators, Walgreens provided testing and vaccines to underserved communities during the pandemic. The company said it administered 40 million vaccines in underserved communities through July of last year via its COVID-19 Vaccine Equity Initiative. Walgreens also administered another 207,000 vaccines at off-site clinics.

Perhaps the most significant health equity efforts at Walgreens revolve around its pilot programs in Chicago. The first phase of the Chicago Health Equity Pilot launched in August 2020 in communities in the city’s South Side and West Side. It involved educating patients about diabetes management, pediatric asthma management and prescription pickup. It saw immediate results, with a spike in prescription pickup rates, the company said.

The second phase launched in June of last year, and includes programs on mental health wellness check-ins, new medication routines and taking prescriptions on time. It also identifies patient challenges to picking up prescriptions and offers free same-day delivery to address transportation barriers. This phase also includes Walgreens team member coaching to enhance patient engagement and support.

The Health Equity pilot also has expanded to additional markets, including dozens of Walgreens locations in the Southwest.

“Health equity is something Walgreens has been focused on for years,” said Dana Erf Fortman, director, pharmacy services and health equity, Walgreens, in a statement on the company’s website. “We have stores in vulnerable communities, and our regional and field leadership have always engaged with these communities. “

Having a specialized health equity team allows Walgreens to unify its disparate health equity initiatives under a more cohesive strategy.

“That way, we can have the largest impact on our patients and our communities,” she said.

The mental health prescription therapy program has been one of the more significant components of Walgreens Health Equity pilot. It has been focused on pharmacies in areas where mental health disparities may be worse due to institutional racism, health insurance access and coverage, inadequate care and treatment and cultural acceptance, the company said.

“Throughout COVID-19, certain chronic conditions have affected underserved populations disproportionately, and that's no different with mental health,” said Giang Tran, behavioral health program manager, health equity strategy at Walgreens, in a post on the company’s website. “But conversations around mental health often don’t happen in underserved communities. They have less access to resources available to them to make healthcare a priority.”

Through Walgreens’ mental health wellness check initiative, pharmacists make an outreach call to patients who are prescribed anti-anxiety, antipsychotic and antidepressant medication. The call is made five days after they begin the prescription. Pharmacists then follow up with a mental health wellness check 45 days after prescription pickup to check on the patient’s progress, review side effects and efficacy, and ensure timely refills.

Patients who received the 45-day outreach calls were more likely to refill their prescriptions and did so more quickly than patients who did not receive a follow-up call, Walgreens said

Likewise, Walgreen’s Chicago Diabetes Health Equity Pilot provided enhanced education and intervention for diabetes patients who were struggling with prescription adherence. The program “significantly improved medication adherence,” the company said.

Other health equity initiatives at Walgreens include partnerships with community organizations, such as Vitamin Angels, through which Walgreens provided a free six-month supply of prenatal vitamins and minerals to women at select stores on Chicago’s South Side and West Side. The company cited research showing that nationwide, nearly 1 million pregnant women have limited access to prenatal vitamins due to gaps in insurance coverage.

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