Walgreens Delivers Wrong Prescription

There is a place for retail health care in the U.S. health care system, but a recent advertisement by Walgreens in the Washington Post seems to imply that the retailer can provide the solution for all that ails the nation's health care system.

"A Common Sense Approach to Healthcare Reform," trumpets the headline of the Walgreens' ad. The retailer, which purchased the Take Care Health Systems line of retail health clinics in 2007, goes on to lament that "America cannot wait another day for health care reform."

Retail clinics may have a role to play in health care reform, but it's questionable how large that role can -- or should -- be. Many retail health clinics are in trouble, and several have closed down. The only way they may be workable is as part of a large corporation, such as Walgreens, that can use the clinics as a loss leader, as long as the clinics lead to more pharmaceutical and retail sales.

After all, this is a company that had $59 billion in sales in 2008, and it has publicly stated that it is focused on "leveraging its core businesses to improve performance and return the company to strong double-digit earnings growth and top-tier shareholder return."

One way they see of improving that earnings growth appears to be by expanding into primary care. In fact, Walgreens has an ambitious plan to integrate its retail clinics, pharmacies, over-the-counter sales and disease management interests, and in its advertisement, it seems to imply that it can provide a medical home for patients.

"We … encourage the government to look no further than our worksite health centers, Take Care Clinics and Walgreens pharmacies to understand the value nurse practitioners, pharmacists and other health professionals are delivering to the health care system each day. … Through preventive screenings, new care points, a new distribution of work, and a new, more transparent prescription-pricing system, we will realign the health care system's incentives and place the patient back at the top of the pyramid," says the ad.

In other words, Walgreens seems to believe in the patient-centered medical home, or PCMH, model, but it also seems to believe that by expanding its scope of services and becoming a primary care provider, it can become that medical home.

Keep in mind, however, that retail health clinics are new to the health care marketplace, and regulations and insurance issues associated with these clinics are still being worked out. These clinics currently do not have to deal with a lot of the regulations and contracts that shackle FPs and other primary care providers. If Walgreens wants to get into the primary care business, it might be surprised to find that its slightly lower prices and sophisticated computer systems do not necessarily equate to increased profitability.

According to AAFP President Ted Epperly, M.D., of Boise, Idaho, Walgreens' intention to expand its scope of services to become a primary care provider is "disturbing and a symptom of a disease. The disease is the lack of a robust primary health care system. In its absence, disruptive innovation emerges. Unfortunately, this doesn't solve anything but just adds to the fragmentation of the system."

And retail clinics do further fragment health care. The Take Care clinics cannot offer the continuity of care that FPs and other primary care physicians can offer, particularly in patients with chronic diseases. In fact, the current setup of these clinics nearly precludes any continuity of care. It is questionable that patients would really see these places as medical homes. After all, the PCMH is about establishing ongoing relationships with patients, and in the retail clinic model, which is not based on seeing the same people repeatedly, how can you build that relationship?

In addition, the retailer lists "access to health care" as a reason why it is so well-positioned to become a primary care provider. Let's look at that claim. Walgreens currently has about 700 Take Care clinics in its stores nationwide, but those clinics are all located in large metropolitan areas, and most are in suburban locations. How is that health care reform? These clinics are not located in health professional shortage areas. They are not in medically underserved urban or rural areas, where access to health care providers of any type has become a crisis situation. So really, when Walgreens talks about its great ability to provide access to care, it is talking about access to care for only a certain type of consumer.

This advertisement may just be the retailer's way of announcing that it wants to be at the health care reform table, but FPs are justifiably concerned about what the retailer sees as its role. Patient-centered primary care is what FPs were trained to do, and it's what they want to do. If a gap has opened up in that model because of an emphasis on procedures rather than on evaluation and management of patients, that doesn't mean FPs can't provide care. Instead, it just indicates that they are not being allowed to provide the care they were trained to provide, and retail clinics, no matter how well-funded, do not have the capability to offer that patient-centered care with the same quality as FPs.

Walgreens would be better off re-committing to the AAFP's list of Desired Attributes of Retail Health Clinics. By partnering with FPs and other primary care physicians, and thus, limiting their scope of practice to the services they can reasonably provide, retail health clinics can help improve health care by directing patients in need who currently don't have a medical home to a primary care physician. But by expanding its clinics' scope of practice in an attempt to become a primary care provider itself, Walgreens is not creating health care reform, it is only making a primary care power grab in limited and profitable markets in the name of health care reform.