HealthAugust 22, 2016

Telemedicine in retail stores: Evolving role of clinics and pharmacy

Since first observing the growing interest in telehealth and remote healthcare, I haven’t tempered my enthusiasm for the field or the collaborative role for pharmacy. In fact, I am convinced that these offerings will become more common and cost effective with advanced enabling technology, growing emphasis on quality of health, greater acceptance/adoption by the healthcare community and the consumer, and continued efforts to curb the current rise in healthcare spend.

Healthcare ecosystem

Since my last blog on the state of telemedicine in retail pharmacy, our healthcare ecosystem has continued to severely impact the U.S. economy. Healthcare spend continues to grow; the forecast is that it will increase to 30% of GDP from the current 20% by 2050. The Association of American Medical Colleges projects that by 2025, the U.S. will face a shortage of 130,600 physicians.

It has become even more evident that we are experiencing an evolution and NOT a revolution in achieving more affordable and greater access to quality of care for all Americans.

Telemedicine ‘free-standing’ kiosks

Last year, there was strong interest and several feasibility studies on the concept of telemedicine kiosks adjacent to the pharmacy in retail stores. The concept of this store kiosk seemed to offer a more affordable option and the potential to play a critical role in supporting both retail clinics and the pharmacy:

  1. Leveraging and highlighting the expanding role and value of the pharmacist
  2. Offering a more cost-effective option to retail clinic “brick and mortar” expenses and staffing challenges of “on premise” nurses, especially in smaller, lower-traffic stores

A year later, and thanks to companies that were willing to “step up” and test the business/practice model, several “learns” were identified:

  1. The kiosk business model for success is still a work-in-progress, since footprint, staffing, availability, scope of services, location, and adoption by the healthcare and the patient communities continue to be ongoing considerations
  2. Several “proof-of-concept” business models were not sustainable

Marketplace dynamic changes and next steps

What has significantly changed in the marketplace is the growing presence and acceptance by the healthcare and patient communities that the retail clinic can be a key provider of care to millions of people. Over the past 5-10 years, we have experienced the growing presence of clinics and an expanding portfolio of offered services. What was once a trend for only the largest chains installing these clinics to drive more traffic into their stores, has now become a very common offering by retailers of various sizes as well. There are now 2,100 retail clinics with a forecast of 2,800 locations within the next two years.

What started as a questionable business model is now maturing into a key stakeholder in the healthcare supply chain, as demonstrated by the retail clinic channel’s commitment and accepted responsibility to play a significant role in advancing the quality and scope of patient care at an affordable cost.

Additional drivers on the growing success of retail clinics are:

  • Obamacare and the continued “graying of America” creating more patients with fewer physicians to provide the healthcare they need than ever before. Public policy continues to emphasize affordability, accessibility, and coordinated care. Emerging retail clinics combat this trend head on.
  • Clinic providers, collaborating with their store pharmacists, expanding their portfolio of core services beyond preventive and urgent care, to providing coordinated care for chronic conditions.
  • Greater acceptance by payers and healthcare communities demonstrating greater alignment with the retail clinics, resulting in a higher quality of care delivered at these locations.
  • Growing affiliations and partnerships with other healthcare providers to help address reduction of hospital readmission costs and to help achieve STAR rating financial and quality objectives. Visits to retail clinics or urgent care centers lead to a $4.4 billion annual reduction in healthcare spend versus emergency room visits. We know that readmissions of Medicare patients cost over $26 billion annually, nearly all of which could be saved if patients were receiving proper care during and after their first visit to the hospital. Integrated healthcare systems, large clinics like Cleveland Clinic, and other regional clinics are expanding their reach, partnering with retail clinics to provide both immediate and chronic care — like a “hub and spokes.” This continuum of care connects the physician and services to the patient with transparency, using video follow-up consultations.
  • Expanding use of electronic healthcare records (EHRs) and information systems enables the communication and sharing of clinical data profiles of patients to help address and mitigate “gaps” between hospital, physician offices, labs, and pharmacies. This can also help align health plan goals and protocols and ensure that patients are provided with a continuity of care within these collaborative programs to improve health outcomes.

  • Development and use of connected diagnostic digital devices continue to grow, enabling the remote clinics to collect standardized data and support chronic management from primary physicians.

Hybrid model of retail clinic with telehealth platform

Telehealth, as an enabling technology platform, seems to make the most sense supporting the business models of the retail clinics. Expanding the portfolio of services of traditional urgent care/preventative care models enables telehealth to communicate between doctor and patient, offering a high level of care and real-time evaluation. Additionally, nurses can use these digital interface consoles to consult in real time with a physician when they encounter urgent care situations they are not trained or licensed to address.

This growing model combining nurse staffing with telehealth consoles extends both the hours and range of care that can be delivered within an existing retail clinic footprint.

To further contribute to the adoption and success of the retail/telehealth clinic model, federal and state governments are recognizing the value of telehealth and implementing favorable rules to provide reimbursement for the growing practice.

Pharmacy should have a ‘seat at the table’ in telemedicine

Being a key stakeholder in healthcare supply chain, pharmacy is strategically positioned to play a very significant role in telemedicine, leveraging the trust, loyalty, expanding role, and physical access to these retail clinics.

New relationships; clarity of practice models, roles, and responsibilities; and subscribing to a platform for interoperable clinical data exchange and documentation still need to be worked out. Pharmacy should be engaged early and stay involved, since this retail clinic/telehealth movement is happening in our stores. Early engagement and involvement will help ensure we have a “seat at the table” as telehealth/telemedicine continues to evolve, grow, and becomes a practice standard.

David J. Fong, PharmD, is president of Dave Fong Rx Consulting, Inc. A former senior retail pharmacy executive for Fortune 100 and Fortune 500 companies, he is recognized as one of the U.S. and Canada’s business and professional healthcare leaders, leveraging his knowledge and experience working with pharmaceutical manufacturers, distributors, retailers, payers, and healthcare technology companies to bring value to the industry and the consumer.

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