American health care is inundated with regulations and practices that make it difficult to improve access. Compared to other developed countries, American patients are underserved, overcharged, and at high risk of not getting the care they need.
Some fixes are obvious. States should continue to expand Medicaid under the Affordable Care Act, for example, and the federal government should address the physician shortage by lowering barriers to foreign-trained doctors.
One idea that almost never makes the list of opportunities to improve health care: consolidation. Mergers and acquisitions usually have a bad name – in the world of medicine. They have resulted in fewer hospital systems and other companies providing services, and fewer insurers paying the bills. Mergers are regularly blamed for reducing competition, raising costs for consumers and, over time, limiting access to life-saving products and services.
Still, not every health care deal is automatically a bad one, and Chicago could be the place for a good one in a fast-growing part of the industry that needs to scale up to reach its potential to serve hard-to-reach populations.
Chicago-based VillageMD (headquartered in the South Loop), backed by Walgreens, has agreed to pay nearly $9 billion for Summit Health, which operates CityMD. The deal follows a similar string of announcements from retail rivals CVS, Walmart and Amazon, which have also been expanding their healthcare capabilities through acquisitions and internal investments.
Momentum is building. For two decades, major retail chains have invested heavily in providing convenient and efficient healthcare. Located in pharmacies, grocery stores and department stores, chains like CVS’s MinuteClinics provide care from nurse practitioners or physician assistants for relatively minor health problems. Patients can come in the evening or on weekends, when most people don’t have to miss work, knowing in advance how much a visit will cost.
At the same time, the chains are moving into primary care for more serious conditions, making access to doctors at stand-alone locations or via phone and virtual appointments.
Devoting more retail space to personalized health and wellness makes sense for brick-and-mortar chains as consumers increasingly shop online for drugs, groceries, diapers, makeup and the like. The COVID-19 pandemic accelerated the trend and also made it clear that large retailers, who provided millions of vaccines, became critical to the delivery of care.
The U.S. primary care market is said to be worth about $260 billion, and it’s understandable that treating patients as shoppers doesn’t sit well with the established U.S. medical establishment. Physician groups have questioned over the years whether retail-owned clinics and offices are undermining quality of care, overprescribing antibiotics or damaging the doctor-patient relationship.
Research shows that the worst fears are unfounded.
On the contrary, by providing same-day appointments after work or on weekends not far from home, retailers reach many patients who would otherwise forego the service altogether. Retail health care tends to attract younger-than-average patients who often do not have regular primary care providers. The quality of service is generally about the same compared to other settings, and more and more retail chains are partnering with hospitals and health systems.
When the retail health care boom began two decades ago, some analysts thought the result would be lower costs, fewer emergency room visits and greater access in poor and rural areas where care is scarce. These benefits have not materialized to the extent expected.
There is some evidence that overall costs are higher, mainly because more patients who would not otherwise receive service are now receiving it – a positive development, in our view. Also, growth so far has been concentrated in relatively affluent urban areas, and the rate of emergency department visits for non-emergency conditions has not changed much because of these newer options.
Give him time.
Consumers like having more choices about where to get help when they need it, and the potential for growth is huge. A recent report by financial giant Bain and Co. predicts that nontraditional companies could grab up to a third of the U.S. primary care market by 2030. Along with the expansion of virtual care, including telemedicine and other fast-growing technologies, long-standing gaps are finally closing.
VillageMD argues that overall health care costs are increasing because too high a percentage of resources are being allocated to mitigating the impact of chronic diseases and too low a percentage to preventing them from occurring. We hope to see this Chicago company and other such innovative retail players pioneer new locations, close new deals and expand the services they offer consumers.
We believe the result will be more and better care for Americans in the future.
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