American health care is awash with rules and practices that make it difficult to improve access. Compared to other developed countries, American patients are underserved, overburdened, and at high risk of not receiving 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 doctor shortages by lowering barriers for foreign-trained doctors.
One idea that hardly ever makes it to the list of healthcare improvement opportunities: consolidation. Mergers and acquisitions generally have a bad reputation — in the medical world. They have resulted in fewer hospital systems and other businesses providing services, and fewer insurers paying the bills. Mergers are regularly accused of reducing competition, increasing costs for consumers and, over time, limiting access to vital products and services.
Still, not all healthcare deals are automatically bad, and Chicago could be the setting for a good one in a fast-growing part of the industry that needs to grow to reach its potential to serve hard-to-reach populations. .
Walgreens-backed Chicago-based VillageMD (headquartered in the South Loop) agreed to pay nearly $9 billion for Summit Health, which operates CityMD. The deal follows a similar series of announcements from rivals CVS, Walmart and Amazon, which are also expanding their healthcare capabilities through internal acquisitions and investments.
The momentum has been building. For two decades, large retail chains have invested heavily in providing convenient and efficient healthcare. Located in pharmacies, grocery stores, and big-box stores, networks such as CVS’s MinuteClinics provide nurse practitioner or physician assistant care for relatively minor health conditions. Patients may come in the evening or on weekends, times when most people don’t have to miss work, knowing in advance how much a visit will cost.
At the same time, chains are pushing toward primary care for more serious conditions, making doctors available at stand-alone outlets, or through 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 pharmaceuticals, groceries, diapers, makeup , etc. The COVID-19 pandemic has accelerated the trend and has also made it clear that large retailers, who have supplied millions of vaccines, have become essential in the delivery of care.
The US primary care market is said to be worth around $260 billion, and it’s understandable that treating patients as buyers doesn’t sit well with the US medical establishment. Over the years, physician groups have questioned whether retailer-owned clinics and practices are undermining the quality of care, prescribing too many antibiotics, or disrupting doctor-patient relationships.
Research suggests that the worst fears are unfounded.
Rather, by offering same-day after-work or weekend appointments not far from home, retailers are reaching many patients who would otherwise forego the service altogether. Retail healthcare 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 as in other settings, and increasingly retail chains are partnering with hospitals and health systems.
When the retail health care boom began two decades ago, some analysts believed the result would be lower costs, fewer emergency room visits and better access in poor, rural areas where care is scarce. These benefits have not materialized to the degree expected.
There is some evidence that costs are higher overall, mainly because more patients who otherwise would not get any service are now getting it – a positive development, in our view. Additionally, growth so far has been concentrated in relatively affluent urban areas, and the rate of ER visits for conditions that are not truly ERs has not changed much due to these new options.
Give it time.
Consumers like having more choices about where they can get help when they need it, and the potential for growth is huge. A recent report by financial giant Bain and Co. predicts that non-traditional companies could capture 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, the permanent voids are finally being filled.
VillageMD says health care costs typically inflate because too high a percentage of resources are allocated to mitigating the impact of chronic diseases and far too low a percentage to preventing them from occurring in the first place. We hope to see this Chicago company, and other equally innovative retail players, open new locations, do new business, and expand the services they offer to consumers.
We believe the result will be more and better care for Americans in the future.
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