What Payers Need to Know As Retail Pharmacies Move Into Primary Care

Chris Sullivan of Wolters Kluwer Health

It’s no secret that the healthcare landscape is changing. In fact, according to a recent survey 61% of Americans believe that within five years most primary care services will be provided at sites such as pharmacies and retail clinics rather than at the traditional doctor’s office.

The industry data backs that up. A study from May by Definitive Healthcare states that retail clinic claims volumes grew 200% from 2017 through 2022. Over the same period, urgent care claims climbed 70%.

While retail pharmacy clinics first focused on “urgent” or “quick” care, they offer great promise for primary care, especially in underserved rural areas where access to a local hospital or health system may not be available. According to the University of Pittsburgh, 9 out of 10 people in the U.S. live within 5 miles of a pharmacy.

For decades, pharmacists have embedded in their communities, acting as trusted healthcare advisors. Such relationships lay a strong foundation for pharmacies to shift from a place for advice on care to an easy and accessible provider of care services.

Pharmacies see a strong opportunity in this shift to expand revenue streams, a welcome shift from operating on the thin margins associated with filling and dispensing medications.

This shift also creates opportunities across the healthcare ecosystem for improved access and moving care to the most appropriate setting. Payers, for example, can partner with these retailers and optimize their role in the ecosystem, in turn helping to drive medication adherence and improve community health by reducing emergency room visits, hospitalization, and readmissions.

While pharmacies represent a shift in the marketplace around the delivery of primary care, this new venue is additive to a primary care market that is struggling to meet a growing need for care. For payers, rather than viewing retail health settings as competition with more traditional providers, these clinics instead offer a valuable tool for keeping care in more appropriate settings. However, with the value expanded care brings, the need for coordinated care grows beyond the information in an electronic medical record.

As retail pharmacy grows in significance in the broader ecosystem, payers need to think about how to ensure that care for their members is consistent. Regardless of setting, care decisions must be based on evidence-based content and supported with strong patient education.

Medical content plays a critical role in building trust throughout the patient and member experience. When patients encounter the same information from their provider, pharmacist, and payer, they’re more likely to trust it. When information is inconsistent, it’s difficult for them to determine which source is trustworthy and identify the one to rely on to inform health decisions, which will impact adherence and outcomes.

Members are eager for more information and look to health professionals to provide it. A recent study revealed that 80% of patients leave their health encounter with unmet questions, and almost 40% of rural patients report that they don't routinely receive patient education, compared to 24% of their urban counterparts. The gap in receipt of educational materials is concerning.

Payers are in a unique position to close this information gap and mitigate negative outcomes by providing credible educational content through multichannel digital solutions. Especially as care is offered in more settings, they can become a more valuable resource by engaging with members with health and wellness information that not only helps inform their decision-making but is consistent with the information they receive from medical providers.

But what about the member? Today patients want to participate more actively and make more informed decisions in their care. Payers have an important role to play in ensuring their members receive the best possible experience that is also cost-effective.

As retail pharmacies move towards supporting chronic care the best outcomes require the participation and education of the patient. And that requires effective educational materials that are:

• Easy to understand and explained in a meaningful way to help members understand the most important points.
• Presented in context and aligned with their care scenario, so it’s easier for them to consider their options.
• Aligns with the medical content used by clinicians.

The expansion of healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. Payers need to align with retail pharmacies as a critical part of the healthcare ecosystem to optimize their role in delivering impactful care.

Chris Sullivan is the vice president and general manger of the commercial segment for clinical effectiveness at Wolters Kluwer Health.