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CONTENTS »» JULY 2022

2 Stretched to the Limit

In long-term-care facilities, who has time to see suppliers when there’s so much work to do?

12 The Job of a Lifetime

Cancer survivors are growing in numbers, and increasingly, physicians and health systems are accompanying them on their lifelong cancer journey..

22 Clinic vs. Clinic

A look at the physician office market.

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The Journal of Healthcare Contracting | July 2022

TRENDS

BY MARK THILL

Stretched to the Limit In long-term-care facilities, who has time to see suppliers when there’s so much work to do?

It’s no wonder that many people call the current staffing situation in

Longstanding issue

long-term care a crisis. Nursing homes lost 220,000 jobs – 40% – from March 2020

More than 1.4 million people live in over

to October 2021, according to the Bureau of Labor Statistics. Compare that to hos-

15,500 Medicare- and Medicaid-certified

pitals, which experienced a 1.6% loss during the same period, and home health, which

nursing homes across the nation. For

experienced a 1.2% loss.

years, those nursing homes have been

“I’ve been in this industry for nearly a decade and this is by far the biggest issue

underfunded and understaffed, often

facing long-term-care,” says Guy Cunningham, vice president of sales for Clock

delivering inadequate care to their vulner-

Medical Supply. “Facilities that never used agency for staff are having to do so while

able residents, according to healthcare

being forced to pay higher wages for directly hired employees. Additionally, staffing

policy experts in a recent issue of Annals

agencies are now having difficulty finding willing participants, which is adding further

of the American Academy of Political

stress on our market.”

and Social Science. “The spread of the

July 2022 | The Journal of Healthcare Contracting

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TRENDS

virus across the country introduced a new

Staff shortages weren’t the only

experience disproportionately high case

emergency to a long-term care sector that

factor contributing to those deaths, of

and death rates during the recent Omi-

had already been in a state of crisis for

course. The highly transmissible nature of

cron surge). Several factors are respon-

multiple decades.”

SARS-CoV-2, the nature of congregate

sible, including high rates of vaccina-

In the past two years, more than

care settings, and the high-risk status of

tion among residents, rising vaccination

200,000 residents and staff in nursing

people who reside in nursing homes all

rates among staff, an increased empha-

homes died from COVID-19 – nearly

played a role.

sis on infection control procedures, and

a quarter of all COVID-19 deaths in

And there is some positive news.

declining nursing home occupancy.

the United States, according to the

According to January 2022 data from

White House. “The pandemic has

the Centers for Disease Control and

highlighted the tragic impact of sub-

Prevention, the share of COVID-19

A watchful eye

standard conditions at nursing homes,

deaths in long-term-care facilities has

The Biden-Harris Administration has

which are home to many of our most

decreased since the start of the pan-

every intention of maintaining the trend.

at-risk community members.”

demic (though nursing homes did

In January, the Centers for Medicare & Medicaid Services began posting nursing home staff turnover rates (as well as

‘ Directors of nursing, administrators, and non-direct-care staff are being forced to work the floors and do the jobs that others once did, and they don’t have time for personal meetings with suppliers/vendors.’

weekend staff levels) on the Medicare.gov Care Compare website, and the agency will be including this information in the star rating system starting in July 2022. “This information helps consumers better understand each nursing home facility’s staffing environment and also helps providers improve the quality of care and services they deliver to residents,” according to the agency. In February, the White House ordered steps be taken to ensure that:

ʯ Every nursing home has a sufficient number of staff who are adequately trained to provide high-quality care.

ʯ Poorly performing nursing homes are held accountable for improper and unsafe care.

ʯ The public has better information about nursing home conditions so that they can find the best available options. The adequacy of a nursing home’s staff is the measure most closely linked to the quality of care residents receive, according to the White House, citing one

July 2022 | The Journal of Healthcare Contracting

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TRENDS

study, published in the Journal of the

rooms increase residents’ risk of con-

required licensed nursing and CNA staff

American Geriatrics Society in June 2020.

tracting infectious diseases, including

to meet government standards.”

That study found that in one state –

COVID-19. CMS will explore ways to

Connecticut – nursing facilities that

accelerate phasing out rooms with three

staff are more prevalent, are managing

increased registered nurse staffing by

or more residents and to promote single-

better than others, he says. “However,

just 20 minutes per resident day encoun-

occupancy rooms.

they are paying up to $7 more per hour

Facilities in urban areas, where willing

tered 22% fewer confirmed cases of

for staff than they have historically. This

COVID-19 and 26% fewer COVID-19

is a result of both supply and demand as

deaths. CMS intends to propose mini-

A willing staff

well as inflationary pressures. Several of

mum standards for staffing adequacy and

Some long-term-care facilities have

our customers have closed entire wings of

will conduct research to determine the

been forced to close for lack of a willing

their facilities to reduce fixed and ancillary

level and type of staffing needed to en-

staff, says Cunningham. “The reason is

costs as well as staffing relief.”

sure safe and quality care. Proposed rules

simple: From a monetary standpoint,

will be issued by February 2023.

inflation coupled with a lack of increased

affect medical suppliers, says Cunning-

Staffing shortages among customers

reimbursement are crippling the indus-

ham. “Directors of nursing, administra-

nursing homes to reduce resident room

try. Census was significantly reduced

tors, and non-direct-care staff are being

crowding. Most nursing home residents

during the pandemic and many [certified

forced to work the floors and do the jobs

prefer to have private rooms to protect

nursing assistants] who had previously

that others once did, and they don’t have

their privacy and dignity, but shared

staffed those buildings left. Some [didn’t]

time for personal meetings with suppliers/

rooms with one or more other residents

want the vaccine and as a result, left the

vendors. My staff used to spend most

remain the default option. According

industry. Now, many facilities can’t accept

of their pre-pandemic days in buildings,

to the Administration, multi-occupancy

residents because they don’t have the

meeting with long-term-care staff, trying

The White House has also instructed

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TRENDS

to understand their issues and pressure points while formulating solutions to help. This has been cut by 70%. [But] this is getting better as the pandemic normalizes to some degree.” Reps can help their customers in a few ways, for example, by assisting them make supply choices that can affect outcomes in a positive way and help with cost-in-use, he says. But such help can only go so far. “It is never my immediate instinct to look to the government for answers to private sector problems, but in this case, they have caused the problem. The only way to fix this, in my opinion, is to increase reimbursement, which will give facilities the ability to pay a competitive wage to those willing to take care of our seniors.”

Nurse practitioners Some believe that recruiting more nurse practitioners will help long-term-care facilities address staffing shortages. In the Journal of Post-Acute and Long-Term Care

‘ It is never my immediate instinct to look to the government for answers to private sector problems, but in this case, they have caused the problem.’

Medicine in February 2022, three researchers made the case that the pandemic “revealed

acute medical problems prior to progres-

a sense, COVID took the life out of that

the consequences of years of inattention to

sion to more complex, life-threatening

for a while, because it isolated staff and

the many challenges facing nursing homes,

situations, prevent adverse outcomes, and

residents from the outside community. But

including lack of access to primary care

reduce resident suffering.”

we’re slowly recovering. Families are back

providers – physicians or NPs [nurse practi-

to visiting on a regular basis, and whether

tioners] – both of whom bring a comple-

they realize it or not, they are providing

Better days ahead?

care, even if it’s not direct patient care.

COVID-19 has presented serious chal-

Their presence gives residents something

care facilities with nurse practitioners

lenges for long-term-care providers, says

to look forward to and helps staff feel less

have lower rates of depression, urinary in-

Dennis Loflin, director, NH Med Services,

isolated in what they do.

continence, pressure ulcers, and residents

an extended care distributor in Denton,

with aggressive behaviors, they said. More

North Carolina. But he believes the indus-

tract COVID from the equation, you’d find

residents experience improvements in

try is slowly recovering, to the benefit of

the culture in these communities has been

meeting personal goals, and family mem-

their communities, residents and staff.

getting better and better. We’ve all worked

mentary skill set to the LTC sector.” Studies have found that long-term-

bers express more satisfaction with medi-

“A nursing home is a living, breathing

“If you go back five or 10 years and ex-

hard to make them seem more like home

cal services. “By being onsite, NPs can

organism. It is a big part of the larger com-

instead of institutions. And they are becom-

identify changes in residents’ status, treat

munity and is home to a lot of people. In

ing much better places to work too.”

July 2022 | The Journal of Healthcare Contracting

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July 2022 | The Journal of Healthcare Contracting

The Job of a Lifetime Cancer survivors are growing in numbers, and increasingly, physicians and health systems are accompanying them on their lifelong cancer journey.

As of January 2019, there were 16.9 million cancer survivors in the United States. That’s 5% of the population. The number was projected to increase to 22.2 million, by 2030, and to 26.1 million by 2040. The number of people expected to live five or more years after their cancer diagnosis was projected to increase 33%, to 15.1 million. In 2019, 64% of survivors were age 65 or older, and it was estimated that by 2040, 73% of cancer survivors in the United States would be age 65 or older. Five-year and 10-year survival rates for those with childhood cancer now exceed 80%. In 2020, there were an estimated 500,000 survivors of childhood cancer in the United States. It’s all good news. But being a survivor doesn’t mean patients or their healthcare providers can leave cancer behind. Patients with a history of cancer live with the threat of recurrence and late effects of treatment. Both they and their primary care doctors need to keep an eye out for treatment-related effects and cancer-related medical issues and comorbidities, even years after the cancer occurrence.

THE JOB OF A LIFETIME

There are approximately 18 million

social determinants of health – which can

of breast cancer are strongly encouraged

cancer survivors in the United States,

determine a survivor’s access to care –

to get annual mammograms. Peripheral

says Lidia Schapira, M.D., FASCO, pro-

can impact outcomes.”

neuropathy – numbness of the feet – can

fessor of medicine at Stanford Univer-

be a sign of chemotherapy-induced nerve

sity School of Medicine, and director

injury. Similarly, liver dysfunction could be

of Cancer Survivorship at the Stanford

Burden of late effects

Comprehensive Cancer Center and

In general, cancers that typically require

Cancer Institute, Stanford, California.

intensive multimodality therapy (e.g., radia-

healthy eating, plenty of exercise – is par-

“When you look at it like that, you can

tion and chemotherapy) carry a higher

ticularly important for patients with a his-

see that every healthcare professional –

burden of late effects, says Dr. Hudson.

tory of cancer, as it can reduce the risk of

primary care physicians, orthopedists,

Examples include brain tumor survivors,

recurring cancer and secondary infections,

dermatologists and others – will have

high risk/advanced stage solid malignan-

says Dr. Abraham. “We are especially

cancer survivors in their panel.”

cies (e.g., sarcomas), Hodgkin’s lymphoma,

mindful of making sure cancer patients

and solid and hematological malignancies

give up potential risk factors. Someone

treated with hematopoietic cell transplanta-

who had lung cancer is encouraged not

Risk

tion. “The prevalence of health conditions

to smoke; someone who had liver cancer

People with a history of cancer can

increases with aging and with increasing

shouldn’t drink.”

experience impairment in function due

time from cancer diagnosis and treatment.

to organ loss (i.e., surgical removal) or

Multimorbidity is common.”

infiltration with cancer, says Melissa

related to radiation-induced lung toxicity.

In many ways, primary care physi-

Promoting overall wellness – e.g.,

Comorbidity

Hudson, M.D., director, Cancer Survi-

cians approach their patients who

Adult cancer survivors are especially sus-

vorship Section and co-leader, Cancer

have had cancer similarly to those who

ceptible to comorbid illnesses, according

Control & Survivorship Program, St.

have not, says George Abraham, M.D.,

to the American Cancer Society. People

Jude Children’s Research Hospital,

MPH,, MACP, FIDSA, president of the

who are treated for cancer, even those

Memphis, Tennessee. “Cancer treatment

American College of Physicians and chief

treated in childhood, tend to have a

also plays a large role, and toxicities are

of medicine at Saint Vincent Hospital,

higher prevalence of chronic illness later

related to specific modality, dose, and

Worcester, Massachusetts.

in life. Age-related health conditions

therapy combinations.” Dr. Hudson is part of The Children’s Oncology Group (COG), a National Cancer Institute-supported clinical trials group, and she is co-author of “Long-

‘ Every healthcare professional – primary care physicians, orthopedists, dermatologists and others – will have cancer survivors in their panel.’

term Followup-Care for Childhood, Adolescent, and Young Adult Cancer Survivors,” a September 2021 clinical

“We watch lipid counts, diabetes risk

appear earlier and with greater severity than might otherwise be expected.

report from the American Academy of

and risk of infection, much as we do with

Pediatrics. The report is based on care

any of our patients,” says Dr. Abraham,

Using 2002-2018 National Health

guidelines developed by the COG.

who is professor of medicine at Univer-

Interview Survey data, among 30,728

sity of Massachusetts T.H. Chan School

cancer survivors, increasing trends were

an important role, and understanding

of Medicine. But there are differences.

observed in the prevalence of hyperten-

mechanisms that make a survivor more or

For example, people with premenopausal

sion, diabetes, kidney disease, liver disease

less vulnerable represent a focus of ongo-

breast cancer may be at risk for early heart

and morbid obesity. Cancer survivors with

ing research,” she adds. “Comorbid health

failure depending on the type of chemo-

multiple chronic conditions increased

conditions can increase vulnerability, and

therapy used, and those with a history

from 4.7 million in 2002 to 8.1 million in

“Health behaviors and genetics play

July 2022 | The Journal of Healthcare Contracting

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THE JOB OF A LIFETIME

2018. The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the prevalence of multiple chronic conditions also increased, but more slowly than among survivors.

The long-term plan Primary care providers – pediatricians, family practitioners, internists, practitioners trained in internal medicine and pediatrics, and advanced practice providers – are likely to have an increasingly vital role in caring for this rapidly growing population, according to The Childhood Cancer Survivor Study, the largest and most extensively characterized cohort of five-year survivors of childhood cancer in North America. But there are hurdles

months.’ But their lives don’t necessar-

says Dr. Schapira. Survivorship care plans

to jump.

ily go back to the way they were before

have been recommended for almost 20

“We consistently hear about long-

their diagnosis. Survivors are dealing

years, but implementation by medical

term consequences of treatment that

with collateral damage, and they lack

professionals remains uneven, she says.

aren’t well managed by the care team,”

regular support and communication. It’s

says Shelley Fuld Nasso, CEO of the

emotionally challenging.”

National Coalition for Cancer Survivor-

“The problem is, the early versions of care plans were long, laborious, and not

Survivorship care plans – which spell

helpful to primary care doctors.” Further-

ship, which conducts an annual cancer

out diagnosis, therapy, potential late effects

more, they were paper-based and difficult

survivorship survey.

and long-term surveillance guidelines – can

for care providers to access and share

While receiving treatment, the cancer

help the patient and primary care doctor

with colleagues. But today, clinical special-

patient is closely monitored by a team of

navigate survivorship. “Part of what we

ists and generalists have access to easy-to-

oncologists, she says. But when treat-

do is empower survivors to be advocates,”

complete forms, such as those available

ment ends, patients may feel they’ve

she says. “But not everyone can or will be

online from the American Society of

been left on their own to deal with the

able to advocate for themselves. And they

Clinical Oncology and other groups.

fatigue, depression and anxiety, which

shouldn’t have to. Having a cancer diagno-

are common. That’s not to mention

sis is hard enough.”

Dr. Abraham says that because large healthcare systems and multispecialty practices share common electronic plat-

longer-term effects, such as cardiotoxici-

forms, secure messaging among providers

ty or heart damage due to chemotherapy, or monitoring for recurrent or additional

The disconnect

is more doable today. “There’s less of a

primary cancers.

Advocates for cancer survivors speak of

disconnect than what we saw with paper-

a disconnect between oncology and pri-

based systems, which relied on dictated

help during the first year after treatment,

mary care, with potentially harmful results

notes and passing paper.”

she continues. “You may be seeing your

for the patient.

Cancer survivors often need special

care team daily, then you’re told, ‘Your treatment is done; come see us in three

Technology is not the only barrier

“I’ll confirm the disconnect, and I’ll confirm it’s not good for the patient,”

to effective communication between oncology and primary care, according to

July 2022 | The Journal of Healthcare Contracting

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THE JOB OF A LIFETIME

experts. Putting together individualized

forgotten they even received such a plan.

“A 25-year-old software engineer,

treatment summaries and care plans isn’t

“Years after their treatment, they may de-

who was treated for leukemia when she

easy, says Fuld Nasso. It calls for coopera-

velop breast cancer or a heart problem,”

was four, moves to Silicon Valley and

tion among medical oncologists, surgical

she says. “They can request their records,

looks for a primary care doctor. But

oncologists, radiological oncologists and

but they don’t need information on what

she is not a typical healthy 25-year-old,

others. Nor is there adequate reimburse-

their blood counts were 20 years before.

and we need her primary care doctor

ment for their time spent doing so. “As

They want a concise plan with all their

to assess her health risks to make

one expert said, ‘If it were easy, it would

treatment information.

sure she gets good advice and care. A

be done all the time,’” she says.

“At St. Jude, we strive to educate

75-year-old man treated with radiation

our patients and families about why the

for early-stage prostate cancer when he

patients who have been treated for cancer

care plan is so important. Some people

was 65 may develop a urethral stric-

need more than a piece of paper or PDF

embrace it; others don’t so much. Some

ture at age 75 and come to his primary

to guide themselves and their physicians

of it is cultural, some relates to health

care doctor with symptoms of urinary

through long-term care plans. “It’s about

literacy. But we need them to understand

frequency. A woman treated with radia-

communication and discussion,” she says.

how their cancer history during childhood

tion to the chest as a college student is

“It’s helping people use the care plan,

can affect long-term health.” Similarly,

at risk for developing breast cancer, and

share it with physicians, see that it is up-

primary care physicians need to appreciate

we recommend screening with mammo-

dated over time, and make sure it remains

that they are caring for a cancer survivor

grams and MRIs, if possible, eight to

tailored to the individual.”

who may have unique health risks.

10 years after treatment. And the car-

What’s more, studies show that

diac health of someone whose treatment included exposure to cardiotoxic

The prevalence of health conditions increases with aging and with increasing time from cancer diagnosis and treatment.

drugs may be affected.” Cancer survivors need to understand their risks and what they need to do to stay healthy. “If they were treated as a child, they may need to learn enough about the disease and treatment to ‘own’

Ownership

their history,” says Dr. Schapira. Similarly,

individuals involved in the care of the pa-

Dr. Schapira’s research has focused on

primary care doctors need to understand

tient anticipate their healthcare needs and

improving communication between

the protocol those patients underwent

surveillance, and make plans to coordinate

patients and physicians. The Stanford

years before and how the exposures to

ongoing care, share responsibilities about

team has opened a faculty-embedded

cancer treatments can affect the health of

education and risk mitigation, and help

primary care practice specifically for

the patients in their office.

the survivor gain access to the care they

cancer survivors and offers a free online

need,” says Dr. Hudson. “Hospitalized

CME course on the care of patients

“How can we include the patient in

patients routinely get a discharge summary

with a history of cancer. “It’s a great

their continuing health in a way that

upon discharge, but cancer patients don’t

resource for primary care doctors and

is empowering but not overly burden-

necessarily get a survivor care plan. “It just

nurses,” she says. Last fall, CRC Press

some?” Several organizations and

makes good sense that they do.”

published “Essentials of Cancer Survi-

associations, including the National

vorship: Guide for Medical Profession-

Coalition for Cancer Survivorship, have

a care plan doesn’t mean the survivor or

als,” edited by Dr. Schapira, for cancer

developed care guidelines for patients

their provider knows what to do with it,

clinicians as well as generalists and

and primary care physicians. “The

she continues. People who were treated

specialists who meet cancer survivors

whole idea is to become more proactive

for cancer in their youth might have

in their practices.

with these tools.”

“Care planning is a process where

Furthermore, the mere existence of

“It’s about co-managing,” she says.

July 2022 | The Journal of Healthcare Contracting

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agile and continuously innovate in ways to

“We’ve added a new distribution

disruptions throughout the world, leaving

meet customer ongoing demands for PPE

center in New Jersey for our medical seg-

healthcare facilities to face increased pres-

by way of emergency preparedness. With

ment,” Campbell said. “We have addition-

sure to secure critical product needed for

their most recent investment, Ansell’s

al network investments in North America

patient care. As the waves of COVID-19

unique manufacturing footprint across the

coming up that will enable delivery of

outbreaks continue to persist, demand

world helps mitigate risk of these disrup-

a full suite of Ansell product portfolios

remains strong while a host of logistical

tions as the very dynamic market continue

within two days to our customers.”

constraints from ports congested to ship-

to embark on the new normal.

Ansell’s ship-to-promise (STP) is

ping container shortages remain.

a key measurement for its customer

Ocean container line schedule reliabil-

experience. “Our global planning tools,

ity dropped to an industry low of 35.8%

given our large reach, help us deliver

in 2021, according to Denmark-based

our products in full and on time to our

Sea-Intelligence, a leading provider of

customers,” Campbell added. “Our

research and analysis for the global supply

reach across many countries allows us

chain industry. That compares to 63.9%

to increase product volumes for delivery

in 2020 and 78% in 2019. It also showed

to our regional locations.”

U.S. consumption at record levels in 2021.

Campbell says it’s been extremely hard

“The demand, coupled with con-

work in supply chain during the past two

strained supply of ocean vessels, hampers

years. But the challenges have reiterated the

the ability to get containers through ports, onto rails and to delivery points,” said

importance of IDNs and supplier partners “It’s important we have redundancy

being connected to the supply chain,

Allison Campbell, Vice President of Global

and dual sourcing capabilities in our

knowing where the demand signals are

Logistics for Ansell. “The market has not

Ansell owned manufacturing footprint as

coming from, having the agility to respond,

seen recovery to pre-pandemic times.”

well as our expanded network of manu-

and integrating different components

Acknowledging the new norm is

facturing partners,” Campbell said. “Our

to serve the customers that rely upon sup-

how to embrace the future. Manufactur-

products are able to be made at multiple

pliers like Ansell. Campbell ends with

ers that are agile in a changing market

locations to increase or expand produc-

“A manufacturer, closely collaborating with

coupled with contingency plans in place

tion as needed. We seek redundancy in

your customer has become paramount.”

is the recipe for building resiliency in

our raw materials supply too.”

supply chain. It’s eminent for healthcare

Current global supply chain con-

manufacturers and supply chain leaders

straints are highlighting the significance

1 2

Learn more about Ansell at www.ansell.com.

Seatrade Maritime News: Container line schedule reliability plunges to 35.8% in 2021 Container News: Sea-Intelligence sees no end in U.S. demand boom

July 2022 | The Journal of Healthcare Contracting

December 2021 • Vol.17 • No.6

Women Leaders in Supply Chain Annual celebration of women leadership from many backgrounds, with many different experiences and mentors.

Allison P. Corry, Assistant Vice President, Procurement, Supply Chain Organization, Intermountain Healthcare, Salt Lake City, Utah

The only publication dedicated solely to the healthcare supply chain.

REACHING 4,400 IDN EXECUTIVES, 2,500 HOSPITAL EXECUTIVES, 600 GPO DECISION MAKERS AND 3,500 SUPPLIERS/MANUFACTURERS

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We are proud to partner with The Journal of Healthcare Contracting. The unique educational content and market knowledge JHC provides serves as a vital resource to the supply chain and GPO communities. The benefit we receive has far exceeded our investment. — Bob Davis, AVP, Marketing & Communications, HealthTrust

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TRENDS

Clinic vs. Clinic A look at the physician office market.

Not long ago, big health systems appeared to be the biggest challenge for

ʯ Amazon Care: Works with

independent physician practices. And truth be told, they probably still are. A December

Care Medical, an independent

2021 study published in Health Affairs showed that from 2014 to 2018, hospital and

practice based in Seattle, to deliver

health system ownership of physician practices increased by 89%, from 24% to 46%.

healthcare to Amazon Care

But increasingly, health systems are competing for the physician market with health

members, and plans to expand the

insurers, drugstore chains and other retailers.

program across the United States. The company provides telehealth

They’re not new to the game. They’ve tried many approaches before. But they’re per-

as well as “mobile care RNs” (the

sistent. Here’s a rundown on what’s happening among some of the big retail players.

latter in a handful of locations).

July 2022 | The Journal of Healthcare Contracting

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TRENDS

ʯ Best Buy: Acquired Current Health

stores. In 2021 CVS announced

ʯ Walgreens: In October 2021 agreed

for $400 million in November 2021.

it would convert as many as one

to invest $5.3 billion in VillageMD to

According to Best Buy, Current

thousand existing stores into

accelerate the opening of at least 600

Health “integrates patient-reported

HealthHUBs, offering treatment

Village Medical primary care locations

data with data from biosensors –

for common illnesses, chronic

– staffed by primary care physicians

including their own continuous

care management, telehealth,

and pharmacists – in more than 30

monitoring wearable device – to

pharmaceutical consultation and

U.S. markets by 2025. (VillageMD

provide healthcare organizations

medical products.

remains independent, but Walgreens

with actionable, real-time insights into the patient’s condition.”

ʯ Walmart: As of September

Meanwhile, Best Buy’s Geek Squad

partnership in 2020 with London-

installs personal emergency response

based Babylon, a telehealth

2021, provides healthcare services

systems, medication management

provider which, in March 2021

(including primary care, x-rays,

devices, remote patient monitoring,

acquired Fresno, California-based

labs, wellness classes) in 20 health

and “Senior Living Safety Systems”

FirstChoice Medical Group, with

centers, called Walmart Care

in the home.

180 primary care and 1,000 specialty

Clinics, in Arkansas, Georgia and

providers. In July 2021 Dollar

Illinois. Walmart Health is building

General hired its first chief medical

seven primary care clinics in

officer, Albert Wu, M.D.

Northeast Florida.

ʯ CVS: MinuteClinic® clinics are in 1,100 CVS Pharmacy and Target

has a 63% ownership stake.)

ʯ Dollar General: Established a

July 2022 | The Journal of Healthcare Contracting

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TRENDS

Along with these retailers add UnitedHealth’s Optum unit, which Bloomberg says has more than 60,000 employed or “aligned” physicians, about half in primary care; and Humana,

Conventional wisdom has it that young people prefer the perceived simplicity and speed of dealing with a retail clinic rather than a family physician or practice.

which is reported to be bringing its primary-care footprint to about 250

patients seek the relationship, local access

companies enjoy, says Dr. Daghestani.

locations in 2022.

and market knowledge.”

“But we respond by investing in the

Austin Regional Clinic is a 42-year-old

future and looking for strategic partner-

multispecialty group with 380 physicians,

ships, whether with large organizations or

Austin Regional Clinic

nurse practitioners and physician assistants.

with local and regional ones.”

All that said, independent practices, such

The Clinic cares for 580,000 patients in

as Austin Regional Clinic, based in Austin,

33 locations in the Austin and Central

practices have over many retailer-based

Texas, remain strong. “Our advantage is

Texas area. It represents 19 specialties, but

clinics is their ability and desire to solve

being local,” says CEO Anas Daghestani,

65% of its physicians and advanced prac-

for total care, not pieces of it, he says.

M.D. “Healthcare is still local, and there

tice providers focus on primary care.

“People need a quarterback to guide their

are pieces you can solve by providing a

It’s true that independent practices

digital experience or applying [artificial

lack the scale and access to the infrastruc-

intelligence]. But at the end of the day,

ture or financial solutions that national

Another advantage that independent

care, and we can be that quarterback.” Chief Medical Officer Manish Naik, M.D., says, “One of the biggest challenges

July 2022 | The Journal of Healthcare Contracting

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TRENDS

companies such as Amazon, Walmart and the others face is that they’re addressing one piece of the puzzle, such as an urgent care issue or something from a menu of common minor ambulatory conditions.” That approach exacerbates the fragmentation of healthcare, he says. “You may address the sore throat, but you haven’t addressed things like blood pressure or blood sugar. You’re not caring for the whole patient. An organization like Austin Regional Clinic supports patients in managing all aspects of care, and if we do a good job of that, the total cost of care is less.” Conventional wisdom has it that young people prefer the perceived simplicity and speed of dealing with a retail clinic rather than a family physician or practice. “It may be harder to attract [young people], but it’s doable,” says Dr. Naik. “You have to provide a digital front door, whether it’s a patient portal, telemedicine or digital access, like online scheduling and text reminders, and we’ve had success doing that. “Still, there’s a limit to what you

‘ People need a quarterback to guide their care, and we can be that quarterback.’

can accomplish digitally. AI or a patient portal are tools like any other tools. But how do you connect that digital care

‘Unfair advantages’

advantages” every which way. “Yes,

with in-person care?” After all, AI is

Retailers and insurers are trying to solve

national companies have access to capital

only as good as the input fed into it, and

for the same issues that all physician

and technology, and they have a new way

that should be based on feedback from

practices are, including access, patient

of looking at things, because healthcare is

clinicians taking care of patients in their

satisfaction, and recruitment and reten-

new to them. But our unfair advantage at

offices, he says.

tion of patients, says Dr. Daghestani. And

Austin Regional Clinic is this: We think of

Young doctors coming into practice

they have significant and impressive tools

ourselves as organized medicine. We are

today were brought up in the digital world

to address those issues. But the challenge

local, we have relationships with patients

and find it easy to adjust to electronic

they face is that they are fragmented

and employers, and for us, healthcare is a

medical records and patient portals, says

from the larger healthcare ecosystem. If

career, not a project.

Dr. Naik. But young doctors aren’t the

retailers are to maintain a presence in the

only ones who are mastering these skills

healthcare market, they would be well-

our respective ‘unfair advantages’ so that

at Austin Regional Clinic. “Some of our

advised to partner with local practices,

independent practices and national compa-

most senior doctors have contributed

such as Austin Regional Clinic, he says.

nies can both be successful, that’s where the

Insofar as competition from bigger

magic can happen. And if we can’t figure

significantly to the progress we’ve made with cutting-edge digital solutions.”

players goes, Dr. Daghestani sees “unfair

“If we can figure out how to channel

that out, we risk further fragmentation.”

July 2022 | The Journal of Healthcare Contracting

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