Retail healthcare is a relatively new development in the U.S. healthcare system, driven by the Affordable Care Act’s expansion of access to care. Today, retail pharmacies are extending their services to become integral players in the delivery of healthcare, and leading the way is CVS Health, which announced last September it would no longer sell tobacco products in its 7,600 stores nationwide. As the company expands its role in the delivery of healthcare, it expects to have 1,500 clinic locations open nationally inside CVS/pharmacy stores by 2017. iBi recently spoke with Mike DeAngelis, director of public relations for CVS/pharmacy, about the company’s evolution and prospects for future growth.
What opportunities has the Affordable Care Act provided for retailers like CVS? How has the act prompted a shift in service focus?
When more Americans have the opportunity to have healthcare coverage and take care of their health, we can only see that as a good thing. As part of our purpose of helping people on their path to better health, CVS Health is focused on helping our customers and patients make informed decisions about their healthcare.
We are uniquely positioned to help educate people about their healthcare options, including providing support in identifying information about health insurance subsidies and the exchanges. As we did last fall, in conjunction with the start of open enrollment, we rolled out a company-wide information and outreach program to help customers gain access to critical health insurance marketplace information, including retail events and brochure displays at our CVS/pharmacy stores and CVS/minuteclinic retail medical clinics.
We are well positioned to capitalize on coverage expansion opportunities in both Medicaid and the exchanges, given our broad retail pharmacy and retail clinic footprint; unmatched consumer insights and B2C marketing expertise; existing PBM [pharmacy benefit management] client relationships under CVS/caremark; 28-percent share of the managed Medicaid market; and 80+ health plan clients, covering roughly 70 percent of the public exchange population. As expected, we are seeing more states expanding Medicaid, and that creates new opportunities.
As for our CVS/caremark PBM clients, they are very focused on coming changes from the ACA, and we’ve had a lot of dialogue with health plans about collaborating on innovative programs that support their overall exchange strategies. Opportunities include participation on preferred or narrow retail pharmacy networks; supporting member acquisition with our retail assets and direct-to-consumer marketing expertise; CVS/minuteclinic support of the newly insured through health risk assessments, care management and wellness programs; and driving improved outcomes and reduced costs by engaging their members in face-to-face messaging campaigns.
What steps has CVS taken toward becoming a healthcare company? Why is this important for the company?
As a retailer, we say that we “think customer.” That means we elevate the customer focus as a priority and make it the way we do business. We engage in activities to understand the customer and demonstrate our customer focus in everyday decisions and interactions. We also devote resources to deliver customer-centered change, and our investment in digital is a great example of this.
At the same time, our retail business is evolving as a healthcare company. What that means for us is more fully serving people’s needs for convenience, affordability and access. It means connecting with physicians and health systems as part of a total healthcare system to help deliver greater access, better outcomes and stronger value. It means offering services to help our health plan partners improve their offers, grow and become more profitable.
We’re also focused on personalization through our ExtraCare loyalty program, but also through programs like Pharmacy Advisor, Maintenance Choice and Specialty Connect.
What prompted the decision to stop selling cigarettes in CVS retail locations? How will stores make up for lost revenue? What initiatives is CVS taking to help its customers quit smoking?
This decision underscores our role in the evolving healthcare system. Now more than ever, pharmacies are on the front lines of healthcare, becoming more involved in chronic disease management to help patients with high blood pressure, high cholesterol and diabetes. All of these conditions are made worse by smoking. Cigarettes have no place in a setting where healthcare is delivered. This was the right thing to do.
While we don’t expect whatever we put in the space behind the counter to make up for the loss of tobacco sales, we do believe that we will more than offset the impact of our tobacco exit over time through increased share across the enterprise. Our business outlook is healthy, and we look at this as an investment—in building the healthcare company we expect to be in the future.
Approximately seven in 10 smokers say they want to quit, and about half attempt to quit each year. So in addition to removing cigarettes and tobacco products for sale, we also launched a comprehensive and uniquely personalized campaign to help millions of Americans to quit smoking.
The CVS Health smoking cessation program, designed with input from national experts, combines the efforts of CVS/pharmacy, CVS/minuteclinic and CVS/caremark to help smokers quit and includes four critical components: an assessment of the smoker’s readiness to quit, education on the information and tools they need to quit, medication support to help curb the desire to use tobacco, and coaching to help individuals stay motivated and prevent relapses.
Smoking cessation services delivered by pharmacists are available at all CVS/pharmacy locations daily, and CVS/minuteclinic nurse practitioners provide counseling through the Start to Stop program, which begins with an assessment to create a customized treatment plan. Patients in our stores also have access to smoking cessation informational materials. These resources are supplemented with information online at cvs.com/quit-smoking, as well as a smoking quit line (1-844-265-4321) operated by the American Cancer Society for additional support and access to services in local communities.
CVS/caremark pharmacy benefits management plan members can utilize those resources as well, and clients may also arrange for onsite services at their locations where their employees can meet with CVS/minuteclinic nurse practitioners and CVS pharmacists at worksite events, such as benefits fairs.
To raise awareness about the health benefits of quitting smoking and how challenging it can be to quit, we launched a successful social campaign—#OneGoodReason—in which we are inviting everyone to share their personal stories of how smoking and tobacco use has affected their lives.
How has the decision to ban tobacco sales impacted the industry? Do you believe other companies will follow suit?
Other pharmacy companies will have to make their own decisions. Someone had to be first, and we made the decision that it would be our company. What we can say is that there is evidence developing that indicates that removing tobacco products from retailers with pharmacies will lead to substantially lower rates of smoking with implications for reducing tobacco-related deaths.
Smoking is the leading cause of premature disease and death in the United States, with more than 480,000 deaths annually. While the prevalence of cigarette smoking has decreased from approximately 42 percent of adults in 1965 to 18 percent today, the rate of reduction in smoking prevalence has stalled in the past decade, pointing to the need for more interventions to cut that rate, including reducing the availability of cigarettes and encouraging smokers to quit.
The results of a study from CVS Health, which were included in a blog at healthaffairs.org, show the enactment of policies to eliminate the sale of tobacco products at retailers with pharmacies in San Francisco and Boston was associated with up to a 13.3-percent reduction in purchasers of tobacco products. If retailers with pharmacies across the country were to forego sales of tobacco products, the result could be 25,000 to 60,000 fewer tobacco-related deaths annually.
What are the benefits of visiting a CVS clinic over a trip to a traditional doctor’s office?
CVS/minuteclinic is complementing and expanding access, but not trying to replace the PCP by becoming a full primary care provider. Half of our patients are seen in the evenings and on weekends, when doctors’ offices are not typically open. CVS/minuteclinic is also affiliated with 41 major health systems, and that number is growing. These affiliations include integration of EMR and physician medical director collaboration. We have 900 walk-in medical clinics—and growing—and we use the same evidence-based guidelines from coast to coast. We are proud to be the only retail clinic provider to have been accredited three times by the Joint Commission, which assures our quality.
We see our role as collaborative with the primary care medical home model and believe we can play a complementary role with primary care practices in providing care to patients. With the shortage of primary care physicians, an aging population, an epidemic of chronic disease, and millions of people getting coverage for the first time under the Affordable Care Act, we don’t have enough primary care capacity in the healthcare system overall.
Approximately half of the patients who use CVS/minuteclinic do not have a primary care physician. In addition, even patients who do have a primary care physician are often unable to get an appointment when they need one. Patients who do not have a PCP are offered a list of PCPs in their area accepting new patients for follow-up. CVS/minuteclinic supports the primary care medical home model and provides visit summaries to PCPs typically within 24 hours of the patient visit.
How are individual stores attempting to integrate the pharmacy, clinic and retail sections of their sites?
No other healthcare company has the same combination of assets as CVS Health. By bringing together our best-in-class businesses into one integrated pharmacy innovation company, we are delivering breakthrough products and services that enable people, businesses and communities to manage health in more affordable, effective ways.
We have the expertise and resources to drive innovation and we are taking an active and supportive role in shaping the future of healthcare through our programs in medication adherence, delivery of care by walk-in medical clinics, and support of patients with chronic and complex conditions.
CVS Health has a portfolio of programs to help people manage chronic disease and connect patients with pharmacists who help them stay on their prescribed medications. Digital capabilities are supplementing these programs to give customers a full view of their prescriptions. CVS Health’s Specialty Connect and Maintenance Choice programs integrate the company’s mail and retail capabilities, providing choice and convenience for patients. CVS Health is also forging strategic alliances with physicians and health plans through both CVS/pharmacy and CVS/minuteclinic to provide clinical support, medication counseling, chronic disease monitoring and wellness programs for their members.
It may be one of our pharmacists counseling a grandmother on why it’s important for her to take her diabetes medication as prescribed by her doctor, or a nurse practitioner being there on a Saturday afternoon to diagnose and treat an earache for a seven-year-old so an unnecessary trip to the emergency room can be avoided, or CVS/specialty addressing the needs of a newly-diagnosed young mother with rheumatoid arthritis to understand how to take the potent medications that will make a difference in her life. iBi