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Money & Policy

Why Doctors Are Coming Where You Live — and Shop

3 trends behind the growth of house calls and medical care in stores


The Mall of America on the outskirts of the Twin Cities has more than 520 stores and restaurants, plus an indoor theme park. Last November, it added something else: the M Health Fairview Walk-In Clinic with five medical exam rooms, lab space for tests, a radiology room and pharmacy services. Anyone can stop in. So far, the clinic has had 745 visits; about 20% were people age 45 to 64.

“I wouldn’t call it an experiment. We want to be where people are. This is about the consumer,” says James Hereford, president and chief executive officer of Fairview Health Services, which runs the clinic with the University of Minnesota.

Adds Jakub Tolar, dean of the University of Minnesota’s Medical School and vice president for clinical affairs: “Is this scalable? I would say, yes. It is scalable.”

3 Trends Behind the Shift in Health Care Delivery

The mall’s health clinic is part of an intriguing shift in how health care is getting delivered in the U.S. Other accelerating signs of change: more doctors and nurses making house calls; Walmart’s first health clinic attached to a Supercenter store; CVS Health’s strategy to offer a broad range of health services in its stores by expanding its HealthHUB and MinuteClinic format and Walgreen Boots Alliance transforming four stores into neighborhood centers for older customers, with more coming.

“They’re taking health care to where people live.”

What’s behind the growth of doctors coming to where you live and shop? Three trends that reinforce one another.

Trend No. 1: The patient is increasingly a customer. Convenience and accessibility are critical for better, cost-efficient health and wellness care.  So, doctors, nurses and other health professionals increasingly will come to the patients’ homes, neighborhood and community.

The consulting firm Accenture estimates there were 2,800 medical clinics in retail spaces in 2017 (the most recent data available), a huge jump from 351 in 2006. And, as Next Avenue’s Beth Baker recently wrote, the American Academy of Home Care Medicine now has 900 members and nurse practitioners are flocking to the field.

Clinics in retail spaces and house calls are two sides of the same trend. “They’re taking health care to where people live,” says Lauran Hardin, senior adviser partnerships and technical assistance at the National Center for Complex Health and Social Needs.

Trend No. 2: The health care industry is shifting its focus from crisis care built around emergency rooms and hospitals toward a system emphasizing wellness and preventative care. Take the CVS HealthHUBs. The first three were opened in CVS stores in February 2019; the goal is to have about 600 this year and 1,500 by the end of 2021. Each HealthHUB has a MinuteClinic, the CVS-owned primary-care service in its stores that mostly deals with minor acute illnesses. But the HealthHUBS offer additional services, ranging from breastfeeding information to stress relief. A concierge helps people navigate their health and caregiving questions.

According to Forbes, CVS Chief Executive Larry Merlo told a JPMorgan Chase Healthcare conference this month that CVS HealthHUBS are focused on offering 80% of what a primary care physician can treat.

“The real goal of the HealthHUBs is to bring different resources across the CVS enterprise in a setting that is easy, local, and convenient,” says Sharon Vitti, senior vice president and executive director, CVS Health/MinuteClinic. “More importantly, it’s to help people stay healthy and drive down the cost of health care… keep them healthy so they don’t need high-cost services.”

Trend No. 3: This one is, in many respects, the most important — the demographics of an aging population. Although the typical MinuteClinic customer is a younger adult, in recent years more older customers have been showing up. So, CVS MinuteClinics partnered with Case Western Reserve University’s nursing school and the Institute for Healthcare Improvement to create training tools and resources making the clinics age-friendly.

The program emphasizes the Institute’s “4Ms” for older patients: What Matters to the patient; Mobility; Medication reduction and Mental and cognitive health.

The rise in house calls by primary care physicians, nurse practitioners and other health care professionals treating older patients partly reflects the realization that it’s much better for those with multiple symptoms to be seen at home.

Medicare has made reimbursement easier, too. Since January, 2019, health care providers have no longer needed to prove the medical necessity for a house call, rather than an office visit, for a Medicare patient.

But various demonstration projects have also shown that house calls are cost-effective compared to the traditional fee-for-service Medicare reimbursement policies that typically push people toward doctor and hospital visits.

Medicare-covered home visits use a value-based payment model — a flat fee per patient for primary care. The Independence at Home Medicare Demonstration Project saw $82 million in cost savings in its first four years, while improving quality of care. And, as Next Avenue recently noted, the American Academy of Home Care Medicine’s research has found that per-patient savings range from $1,000 to $4,000 annually, due to fewer hospital and nursing home stays, emergency room visits and trips to specialists.

The value-based repayment model works well with private insurers’ Medicare Advantage plans, too, which stress improving the quality of everyday life for people 65 and older.

“I have been involved in home care for twenty-five years. We are at a tipping point with the aging of the society. The care makes such a difference to people lives,” says Dr. Thomas Cornwell, CEO of the Home Centered Care Institute and founder of Northwestern Medicine HomeCare Physicians.

Slowly but surely, health care is coming to where you live and shop. That’s convenient for you and your parents and the evidence suggests it might reduce the high cost of health care in America, too.

Chris Farrell
By Chris Farrell
Chris Farrell is senior economics contributor for American Public Media's Marketplace. An award-winning journalist, he is author
 of the books Purpose and a Paycheck:  Finding Meaning, Money and Happiness in the Second Half of Life and Unretirement: How Baby Boomers Are Changing the Way We Think About Work, Community, and The Good Life.@cfarrellecon

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