President's Letter

Tags: Mergers, acquisitions, CVS, aetna, walmart, presidents letter, q2 2019

Mergers, acquisitions, and the family physician — where do we fit in?

By Rebecca Hart, MD
TAFP President

Recently I have been hearing a lot of angst from colleagues about all the impending mergers of large retail corporations, insurance companies, and pharmacies starting up primary care clinics complete with urgent care, lab, imaging, and other amenities. My colleagues are gnashing their teeth wondering if they’ll be forced out of business by yet another corporate takeover. First the hospitals, now this.

The CVS/Aetna partnership brings us HealthHUBs in CVS stores, a health care “destination” with nurse practitioners at the helm and a “care concierge” to direct the patient to CVS services. They are associated with physicians only as reviewers of the NPs, because this is required by Texas law. They are not even on the payroll, but act as consultants — a very distant role. These physicians are not involved in directing the company or directing the primary care at all.

The new BCBS/Sanitas partnership will open 10 new clinics in Dallas and Houston in direct competition with the CVS product, as well as all of us in those cities. At the same time, Walgreens has partnered with Houston-based Village MD to create a physician-led partnership to open clinics in local Walgreens stores called Village Medical at Walgreens. Meanwhile, Walmart is opening Walmart Care Clinics in their locations, with a $4 price point for Walmart health plan participants. Again, nurse practitioners are at the helm of these clinics.

In an article entitled “Disrupting Primary Care in the Lone Star State” from the April 12, 2019 Gist Healthcare report, the authors note: “Texas has become a testing ground for disruptors looking to refine their consumer-focused care offerings. Coupled with the highest number of urgent care and freestanding EDs in the U.S., the state is now the epicenter for new access and care services. Health care leaders nationwide should closely monitor the Lone Star State to see how these experiments evolve, and how they impact traditional providers.”

Wow. It’s all starting here in Texas. Usually it’s great to be a trendsetter, but I’m not sure this is the trend I want us to set for the nation. What happens here over the next couple of years could be the beginning of a nationwide epidemic of corporate primary care in retail centers everyone knows. Will there still be room for us family physicians in private practice, or for that matter in regular practices or even in large groups? Is this really the future of primary care?

TAFP has submitted a resolution to the TMA House of Delegates calling for a concerted effort among physician organizations to pursue a multi-year strategy of developing and supporting public policy options that assure fair business practices and enforceable protections from predatory behavior. Such a strategy would begin with a comprehensive study of developments in the Texas health care market designed to assess how this rapid consolidation and vertical integration of health plans, health systems, and corporate health organizations affects patient choice, physician practice choice, and the economic viability of independent physician-owned practices.

As a physician in a small group practice with four family doctors, I think the structure of these new models could make all the difference in whether our practices are actually disrupted or not. If these corporate entities work with existing family doctors in communities to coordinate the practices, the clinics could enhance access for patients without competing with us. They would sort of fit in as another level of care. They could hire medical directors from local doctors to head up primary care teams at the clinics. Or they could partner with existing clinics for services that go across the care spectrum from doctor to ancillary at the clinic. Or, they could use the Village Medical model and have a family doctor running the clinic located in the pharmacy.

I doubt all patients will want to have their doctors located at a pharmacy or a Walmart clinic. There will always be room for that trusted doctor-patient-relationship-centered care done at our offices, or in DPC offices with 24/7 access via technology. Moreover, the number of patients needing primary care far outnumbers the number of family physicians, nurse practitioners, and physician assistants available to see them all, so we do need something new to help us meet this ever-increasing demand for our services. I wonder if these retail clinics will locate in rural areas, extending access where it’s needed most.

My hope is that the corporate entities partner with us with the understanding that primary care is best delivered with each professional working at the top of his or her license. Family doctors at the helm of these teams can make a big difference in the quality of care the clinics could provide, which gives me hope that these accessible, convenient centers may be successful. But only if they do it in a way that respects the local doctors, partners with them, and works for the best interests of the communities they serve.

For our patients, I say “buyer beware.” Does a corporate entity ever truly care for you as a patient rather than their bottom line? Do you really want to go to a clinic run by your insurance company?

Think about it.

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