CVS

Big Box Medicine? Yes!

I’m stuck at the intersection of harried and impatient, CVS pharmacy pick-up.

When a staffer yells, “Consult!”, customers grumble like a time-eating latte request had infiltrated the black coffee line. I smile, bearing witness to what is fast-becoming nostalgia -- actual in-person interplay with a licensed medical professional.

I’m imagining how the pharmacy and its retail personality will morph as big-box and digital behemoths enlarge and repackage their patient pathways and services.

CVS, Walgreens, Walmart and Amazon are pumping billions into new insurance partnerships and subscription services, home care, clinics, dentists, audiology, X-ray techs and behavioral counselors.

They want to be our medical homes for everyday maladies that needlessly jam emergency departments and for annual shots, labs and cleanings. Their sales pitches lean on convenience, simplicity and, relentlessly, connectivity.

The retailers are targeting the low-hanging, fixable dysfunctions in our sort-of health system, profitable process improvements, coupling one-stop shopping for health and household needs.

Sick, no doctor? How about a Costco clinic visit concluded by stuffing your cart with cheesecake, detergent and potting soil before retrieving your RX? Our mishmash of urgent-care centers can’t top that.

CVS, which owns the insurer Aetna and MinuteClinic, is spending nearly $11 billion to expand its pharmacies and health insurance plans into primary care medical practices, especially Medicare. Amazon has invested nearly $4 billion in a similar venture with annual memberships.

Big hurdles include shortages of providers, state curbs on reciprocal licensing and limits on the scope of some medical practices. Then there’s possible bad photo ops of full service becoming too full.

Retailers extol a new “digital ecosystem.” Algorithms, artificial intelligence, your medical history and your pulsating BP and real-time blood glucose infused to your smart phone.

No surprise, more patient involvement is required. Think about your last lab trip. Aside from a phlebotomist’s draw, didn’t you do most of the computer-entry work?

I’m excited by multimedia public education involved in building Walgreens or Walmart patient health homes, links to neighborhood centers and easing disparities, possibly using promotores, community health workers, for Hispanic outreach.

This is a small part of restructuring the legacy healthcare marketplace which still regards tertiary-care hospitals as everything’s medical hub.

Hospitals would remain a linchpin for in-patient critical care but would be more sharply branded and educationally defined by what they are not.

The United States acted nobly when it broadened care for its citizens, introducing Social Security in 1935, Medicare and Medicaid in 1965 and the Affordable Care Act in 2010.

The system has fallen flat in patient education and preventing remediable problems from resurfacing as critical-care needs. Hospital invoices remain more indecipherable than the Dead Sea Scrolls. If there’s no clarity, there should be no government reimbursement or licensure.

Even in framing their survival strategies, hospital execs aren’t patient friendly: “harnessing inefficiencies … embracing alternate payment models … creating a symbiotic relationship between hospitals and vendors.”

While I futilely pursuing an ear specialist, his phone tree repeatedly reassured that my time and patience were valuable and that I should treat whoever answers the phone with kindness. The scars of Covid remain fresh.

Medical mail retailers are spared the 24/7 overheads of hospital trauma centers, the plethora of state-specific earthquake mandates and billions in uncompensated care costs.

Vacant strip malls and regional shopping complexes are being revived as condos, homes for the unhoused and new retail-medical partnerships. The Urban Institute reports the nation has 1 billion square feet of surplus or obsolete retail space.

We shouldn’t continue to merely reset acceptable levels of deterioration in healthcare access. Opponents of the Affordable Care Act warned that if we educated consumers a little, they’d consume more medical services and worsen the costly logjams.

I’ll wager that there are successful retail business models in right sizing care for non-urgent needs, alleviating a chunk of “sit, wait and ache” emergency department visits.

I’m imagining healthcare shifting from complaint driven to compliment inspired. I’ll grab chocolate bark at checkout to feed that buzz.

John G. Taylor is a former journalist and retired California hospital system executive. He lives in El Dorado Hills, CA.