By Dan Diamond
And three were created by a pharmacy chain.
Walgreens’ move into shared savings is many things: unusual, eye-catching, a sign of the times.
But it’s not surprising, observers say, as the pharmacy chain has been cultivating a broader strategy to ramp up its role in frontline care. And through a handful of new programs, Walgreens already has “demonstrated … the valuable role our pharmacists can play working with physicians to meet the triple aim” of improving patient outcomes and satisfaction while cutting health costs, spokesperson Jim Cohn told me.
“ACOs are the next step.”
Pharmacists’ Role in Care Provision
Of course, “next step” implies there was a first step, and Walgreens’ path toward frontline health services began in 2006, when the chain launched its first in-store health clinics, staffed by nurse practitioners who treated walk-in patients for the common cold and other ailments. Walgreens now has more than 700 of these clinics.
Walgreens subsequently began redesigning its stores to bring pharmacists out from behind the counter to sit at open desks and offer medication consults. Last year, Walgreens launched WellTransitions, a program designed to reduce hospitals’ readmissions rates by sending medication lists to a patient’s primary care provider, performing medication reviews for partner health systems and delivering other services related to drug therapy.
Meanwhile, the perception of pharmacists has been changing — partly because of Walgreens’ efforts, partly because of underlying changes in health care.
Increasingly, pharmacists are being deployed at the point of care at integrated health systems like Kaiser Permanente, to perform medication therapy management — assessing a patient’s current drugs and interactions — and personalize a medication care plan.
While pharmacists working at a retail chain have a different set of responsibilities, these “pharmacists are perfectly positioned to help address the drug ‘adherence’ problem,” Michelle Andrews wrote for Kaiser Health News/Los Angeles Times in 2011. “Research shows that only about half of people take their medications as prescribed,” which leads to higher costs and complications, Andrews noted. And pharmacists are capable of providing reminders, through their frequent patient interactions.
Mechanics of the New ACOs
But for all of their advancements in supporting care delivery, pharmacists can’t offer diagnoses or actually prescribe medicine. And they are not recognized as providers under current law.
(The National Community Pharmacists Association and the National Association of Chain Drug Stores just this week lobbied federal officials to “expand the role of pharmacists in the various new innovative programs” supported by the Affordable Care Act, including ACOs, and specifically to “gran[t] pharmacists provider status for the purpose of participating in Innovation Center projects.”)
Given these limitations, Walgreens — which was eying opportunities to have a foothold in the ACA’s shared savings program — needed partners to actually launch its ACOs.
The chain will partner with a physician group in New Jersey to create Advocare Walgreens Well Network and a Florida-based clinic to launch the Diagnostic Clinic Walgreens Well Network. The company also has teamed up with a Texas-based health system to launch Scott & White Healthcare Walgreens Well Network.
The new ACOs will draw on Walgreens’ accessibility: Unlike doctors’ offices, the chain’s pharmacies are open every day of the year and some of its locations are around-the-clock. Walgreens locations also can provide basic services “such as transitions of care, medication adherence management, immunizations, [and] health screenings,” Cohn told me.
“Some of the things we’re looking at include information relevant to a patient’s treatment and medical condition,” he added. “That will be stored electronically on a secure platform, allowing health care providers and medical staff more visibility to help create care plans for patients.”
“The way I like to describe it is as a physician-led plan where we’re an active partner,” Walgreens Senior Vice President Jeffrey Kang, who leads the chain’s ACO efforts, told the Washington Post’s Sarah Kliff. “They’re the quarterback who creates the treatment plan. We can be care extenders who help implement and execute the plan.”
Underlying Market Economics
It’s telling that most of Walgreens’ coordinated-care efforts, to this point, haven’t been expected to produce much revenue for the chain. And given the ACA’s restrictions, it’s still unclear how or if pharmacists can be financial participants in ACOs, although Cohn told Pharmacy Today that “Walgreens as a whole will be participating in the savings.”
So why is Walgreens getting into this new market?
There’s some speculation that it wants to move away from traditional retail pharmacy distribution. And the chain had an occasionally difficult 2012. In one troubled period, its haggling with Express Scripts, one of the nation’s largest pharmacy benefit managers, prompted Express Scripts to send its customers to CVS and other Walgreens’ competitors for nine months. One Chicago business writer called the episode the “worst corporate blunder of the year.” However, the firm’s prospects have rebounded; a handful of analysts have touted its stock and, as of press time on Wednesday, Walgreens is trading at an 18-month high.
Regardless, the Affordable Care Act means that there will be new opportunities for the chain to participate in the nation’s health system.
“With nearly 70 percent of the U.S. population either without a primary care physician or not utilizing one, and more than 30 million people gaining insurance coverage in 2014 under health care reform, we are well-positioned to fill the void in care,” Walgreens President and CEO Greg Wasson said at last month’s shareholders meeting.
And Walgreens’ three ACOs may just be the starting point. “We will be looking to expand and form future ACO relationships,” Cohn told me.