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The In-Store Health-Care Clinics and Drug Coverage Plans

(8/15/14)- In our item dated 7/5/12 below, we pointed out that Walmart has been lagging behind in its health-care clinic operation, mainly because of outsourcing that aspect of its store operations. The company has now opened 5 primary care sites in South Carolina and Texas and just opened a sixth one in Palestine, Texas. These primary care centers will offer a broader range of medical treatments than the 100 or so acute care clinics leased by hospital operators at various Walgreen stores

The company is specifically aiming for more primary-care business in rural areas that have needs for competent medical services but which are very sparse in some localities. Walmart will be partnering in this business with QuadMed to help staff and operate these new centers.

Each Walmart primary care clinic will have a supervisory physician who will oversee compliance and prescription orders at one or two locations. The clinic will be staffed by medical assistants and nurse practitioners. The clinic will charge $40 a visit, but employees of Walmart and their dependents who are covered under Walmart’s own health-insurance plans, will pay only $4 a visit. It will accept Medicare but not 3rd party insurance. It is starting to enroll some of the stores in Medicais also.

(4/10/14)- CVS-Caremark is the largest chain-drug store company in the in-store health clinic business with about 800 MinuteClinic locations in some 28 states. No appointment is necessary, although wait times can be substantial at the clinic. That of course brings up another matter, namely how frequently do you get to see your doctor within 15 minutes of the “appointed” time?

CVS plans to open about another 150 MinuteClinics as it seeks to expand this type of business, in addition to its prescription benefits management (PBM) operation.

Walgreen has more than 400 Healthcare Clinics, and plans to open about another 100 this year. Target currently has 70 such clinics in its stores, with another 10 being added in 2014.

(3/2/14)- With a substantial additional number of people having medical and drug coverage as a result of the Affordable Care Act, drug stores are seeing this as an opportunity to expand their in-store health clinics, since patients will have longer waits to see the physicians.

CVS Caremark Corp, the chain with the most in-store clinics, wants to double its MinuteClinic locations to about 1,500 by 2017. Walgreen Co. plans to add 100 more clinics this year, bringing its total to 500. The consulting firm Accenture estimates the total number of in-store clinics could grow to 2,800 by next year from about 1,400 in 2012

(4/7/13)- Walgreens announced that its in-store "Take Care Clinics," run by nurse practitioners and physician assistants, will now offer chronic disease management at over 330 of its locations.

The new services will include diagnosis, treatment, and monitoring for chronic conditions, such as hypertension, diabetes, and hypercholesterolemia. In addition, new preventive health services will be offered; for example, screenings or blood tests may be ordered based on a patient's age, sex, and family history.

(3/6/13)- Rite Aid Corp. announced that it would open 58 stores across four markets that would contain virtual doctor visits conducted via Web cameras. The walk-in clinics would charge patients $45 for a 10-minutes consultation with a doctor on a computer monitor.

The program will be rolled out in Baltimore, Boston, Philadelphia and Pittsburgh. A pilot program has been operating in nine stores in the Detroit area.

Walgreen Co. has formed three accountable-care organizations with physician groups in Texas, Florida and New Jersey, and we would expect to see more of this type of alliance spread among more of the drug-chains and doctors groups throughout the country.

(8/29/12)- Wal-Mart Stores Inc. has begun offering 10 immunizations at its health clinics for infectious diseases beyond the flu and pneumonia shots that it already offers now. The Centers for Disease Control and Prevention recommends these shots, which will include shots for shingles, meningitis and the human papilomavirus or HPV which can lead to cervical cancer.

Please see our article on shingles since this writer was part of the trial group in the development of the vaccine.

The vaccinations will be available via pop-up kiosks at the front of Wal-Mart stores, under a contract with Mollen Immunization Clinics, which manage a registered-nurse network out of Scottsdale, Arizona. The Wal-Mart network currently has about 2,700 stores in its system.

The shots will be administered by a registered nurse, not the pharmacist in the store. The company will send the patients' vaccination records to their primary care doctor electronically upon request.

(7/5/12)- Wal-Mart, which now hosts 149 health-clinics in its stores, is lagging behind in its effort to become a leader in this field. At last count, Walgreen has more than 350 in-store clinics, while CVS has about 600, Target Corp. has 44, and the Kroger Co., the grocery chain, has 80.

Health-care experts say that Wal-Mart is lagging in this area because it has outsourced these facilities to outside professionals such as hospitals that are more interested in bringing the business into their own facilities rather than having the repeat business go to the Wal-Mart clinic.

The other retailers have purchased clinic operators and taken control of their pricing and service standards. CVS has announced that it plans to have over 1,000 of these clinics in operation in its stores by 2016.

(1/15/12)- Gregory W. Watson, the chief-executive officer of Walgreen Company, speaking at the company's annual meeting in Chicago, defended the company's position in its battle with the prescription benefits manager (PBM) Express Script after being dropped from the Express Script network as of December 31, 2011.

Analysts estimate that Walgreen could lose more than $4 billion in annual revenue as a result of no longer being in the PBM's network. Walgreen filled more than 80 million prescriptions through Express Script, which represents about 11% of the 819 million prescriptions filled by the chain in 2011.

Walgreen, which is headquartered in Deerfield, Ill., is the nation's largest pharmacy chain store, operating over 8,200 outlets in the United States.

To counter the loss of the Express Script business, Walgreen lowered its discount drug club's price to $5 a year for individuals, and $10 for families. Normally the membership fee is $20 for individuals and $35 for families.

(11/18/11)- As discussed in our item dated 5/16/09 below, Wal-mart has not been able to achieve the success it had hoped for with its walk-in clinic business in its pharmacies. The company is now making another attempt to enlarge its business and to become "the largest provider of primary health-care services in the nation."

The company sent out a letter to many health-care companies last month seeking "strategic partners" for its quick-service clinics. As of last count, according to Merchant Medicine, a medical data consulting firm, Wal-Mart still only has 141 of its stores offering this service.

This compares to the 645 clinics in CVS Caremark drug store outlets, and the 347 in Walgreen pharmacy outlets.

(9/5/09)- To clarify our item dated 9/2/09 below, Caterpillar will keep its benefit manager to handle rebate negotiations with the drug manufacturers. These rebates can amount to a considerable amount of money, as is shown by the fact that Medco Health Solutions, one of the largest of the PBMs collected $4.45 billion in rebates from manufacturers last year. It in turn passed 82% of the rebate to the health-care provider that bought the drugs.

Although Caterpillar will design its own price list, most companies feel that they don't have the expertise to do this. With control of a price list, benefit mangers can save health-care providers money by pushing manufacturers for rebates.

(9/2/09)- Caterpillar Inc. announced that Walgreen Co. will offer prescription drugs directly to its workers, retirees and dependents starting January 1, 2010. This program is similar to the pilot program that the company has with Wal-Mart Stores Inc., which was due to end this year, but now has been extended for two years.

The agreement means that employees of the company will not be using the services of prescription benefits managers (PBMs), since the participant will be dealing directly with the seller of the drug.

Caterpillar will negotiate pricing directly with Walgreen and Wal-Mart instead of using the services of a PBM to accomplish the cost. Both Walgreen and Wal-Mart will offer Caterpillar employees or retirees discounts on non-pharmacy goods.

The pact with Caterpillar is the first time Walgreen has worked directly with a company to supply prescription drugs, though it already manages a network of onsite health-care centers for major companies, including Walt Disney and Toyota Motor Company.

Caterpillar has about 70,000 workers, retirees and dependents

(5/16/09)- Wal-Mart Stores Inc had originally hoped to have 400 walk-in clinics by 2010, but only 17 of the original 78 clinics that it opened have managed to survive. The company recently re-instituted the plan, and now has 33 clinics throughout the country, of which 26 have hospital affiliations.

Back in December, RediClinic, a privately held company backed by Steve Case, the AOL co-founder shut down 15 of its Wal-Mart affiliated clinics.

Wal-Mart Stores Inc. announced that it would be expanding its pilot prescription drug program that we discussed in our item dated 1/26/09 below, to other companies besides Caterpillar Inc.

In affect the company is taking aim at the prescription benefits business (PBM) model, since the employee will be buying directly from Wal-Mart's network of in-store pharmacies rather than from a PBM. There will be no co-payments required from the drug purchaser, and the price of the drug will be determined by the cost of the drug, plus a fixed percentage mark-up on the drug.

Wal-Marts cost for the drugs is not revealed to Caterpillar, but is verified by a third party. The mark-up guarantees a profit for Wal-Mart, while reducing the cost to Caterpillar.

Wal-Mart hopes to benefit also by bringing additional traffic into its store, where additional purchases may be made

(3/19/09)- Wal-Mart Inc. continues to expand into the health care field with its latest move being its entrance into the electronic health records field through its Sam's Club division. The company will team up with Dell for computers and eClinical Works, a privately held company in the software field. President Barack Obama's stimulus package also has allotted billions of federal dollars towards increasing electronics health records in this country.

The Sam's Club offering will be made available in the spring for about $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. Only about 17% of the nation's physicians are using computerized patient records according to a government survey, the results of which were published last year in The New England Journal of Medicine.

Dell will offer and install either a desktop computer or a tablet personal computer, while eClinical Works will provide the electronic record and practice management software, for billing service over the Internet. eClinical will handle the software installation, training and maintenance, with all this being done under the auspices of .Sam's Club. Wal-Mart will have the system operational in all its clinics that are part of its medical system already, as we describe below.

There are about 200,000 health care providers already among the 47 million members of Sam's Club. Wal-Mart stated its clinics in September 2006,and there are presently 30 such clinics in eight states

(1/26/09)- Both Wal-Mart and Walgreen are expanding their in-store health clinics as they pursue corporate and municipal employees business. Wal-Mart announced recently a pilot program with Caterpillar Inc. to allow that company's 70,000 plus employees, retirees and dependents to fill prescriptions with no co-payments at Wal-Mart pharmacies.

(5/14/08)- Wal-Mart announced that it would expand its discounted prescription drug program to offer 90- day supplies for $10. It also announced it would lower the price on more than 1,000 over-the-counter drugs.

The company has begun filling prescriptions for up to 350 generic drugs at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer.

Wal-Mart also added several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone therapy.

Target Corp. also announced that it would match all facets of Wal-Mart's discount prescription and over-the-counter drug plan.

(3/22/08)-Look for your local Wal-Mart to become an increasing player in the health care delivery system in the United States. This will be the start of big name national retailers and pharmacy chains entering the health field in a unique way in a large way.

These operations will partner with local hospitals who may not have an ownership stake in the in-store clinic or split a stake in the facility. For companies like Wal-Mart, it gives the community within which it operates an improved image of the company by providing an accessibility to health care service. For the hospital, it provides a way to expand its access to care and extend its primary care network.

In Houston the H.E.B. grocery chain has split a stake with RediClinic and Memorial Hermann. On its web site, RediClinic describes itself as "high-quality, affordable healthcare that fits how we live today. No appointments, no waiting – and routine treatment and preventive care in about 15 minutes. RediClinic's staff provides convenient and affordable treatment for more than 25 common conditions, such as strep throat and ear infections. They also provide health screening tests, vaccinations, immunizations, and physicals". Memorial Hermann’s mission is "to improve the health of the people in the communities they serve. Memorial Hermann serves the greater Houston community through 14 hospitals and many specialty programs and services". The are finding ready partners with retail operators

Steve Case, who stepped down as AOL Time Warner chairman in 2003 and last year founded Revolution Health Group has investment in InterFit Health, driving the expansion of that company's RediClinic retail clinic division.

This type of retail clinic is expected to grow from about 500 clinics to 1500 by the end of 2008. One of the largest of these retail clinics is MinuteClinic, which in a recent survey (Sept. 2007) had 168 clinics in 24 states. On its web site it describes itself as: "MinuteClinic’s team of board-certified practitioners are trained to diagnose, treat and write prescriptions (when clinically appropriate) for a variety of common family illnesses to patients 18 months and older. MinuteClinic is in-network with most major insurers, so patients are responsible for either their copay or the price clearly listed on our treatments and services menu. For those who are uninsured or prefer to pay out-of-pocket, MinuteClinic accepts cash, checks and credit cards."

They are providing on-the-spot health service to those who do not have a primary care physician, or those who want quick emergency service for relatively minor ailments or those who have no insurance and are willing to pay low fees for service. MinuteClinic posts a price list on its web site for various treatments.

Staffing in these clinics usually consists of nurse practitioners or physician assistants, with physician supervision. While the AMA found these clinics "controversial", they decided that the clinics fit AMA policy that encourages "multiple entry points" into the health care system. The AMA has developed principles for in-store clinic operations that tries to ensure patient safety and continuity of care. The question is how well will these standards be monitored as well as whether it is ethical to "refer" patients to your own service. The latter is a concerned expressed by Susan Strate, MD, immediate past chair of the Texas Medical Association's Council on Socioeconomics who felt that the hospital partnerships will result in lowered private primary care physician visits with more patients going to hospital clinics for follow-up care. Pressure will then be put on hospital clinics to lower their waiting time for service and provide greater continuity of care, not using rotating residents as service providers. This may strain the resources of the medical center.

Another important issue is whether this type of service is fragmenting the health service delivery system, setting up a battle between private practice physicians and medical centers. Our future articles will address many of the issues expressed in this first installment.

(2/11/08)- Wal-Mart has leased space to 78 clinics in its stores across the country. The clinics are operated by independent firms, including 23 by Check-Ups, 13 by RediClinic, a unit of Steven Case's Revolution Health Company, and two by hospital companies in Wisconsin and Florida. Unfortunately CheckUps has decided to close the 23 walk-in clinics it operates in Wal-Mart stores in Florida, Louisiana, Mississippi and Alabama. Steven Case was the co-founder of AOL, which in turn was sold to Time Warner several years ago.

Check-Ups, which is based in New York, fell behind in paying its vendors and nurses late last year. It owes about $108,000 to Medtracker Personnel, a Louisiana employment agency that provides nurses for CheckUp clinics.

William Armstrong, a spokesman for Check-Ups, said Jack Tawil, the chief executive of the privately held company, was talking to investors and "evaluating which of the operations in the retail stores they should keep open."

Wal-Mart said it hoped the Check-Ups clinics would not stay vacant for long. "We are working to reopen the clinics as quickly as possible, whether or not they are operated by CheckUps," a spokeswoman for Wal-Mart said. Check-Ups still holds leases on the spaces, which are typically near the store's front entrance.

Wal-Mart said it plans to have about 400 store clinics by the year 2010. Although Lee Scott, the company's chief executive said last year that the chain could serve as landlord to as many as 2,000 clinics by 2014, the company recently announced that it would take over the clinics itself under the brand name of Clinic at Wal-Mart.

Wal-Mart would use a standardized format and jointly brand with hospitals and medical groups. The first of the new Clinic by Wal-Mart walk-in centers is expected to open in Little Rock, Ark., in April and will be run by nurse practitioners employed by the St. Vincent Health System, a three-hospital group in central Arkansas.

The company went on to say it plans to brand 200 of their new clinics with RediClinic. RediClinic plans to open one of the new units in Atlanta in April, and another in Dallas next summer. It is estimated that the drugstore chains CVS and Walgreen have opened about 700 of this type of clinic in their pharmacies in the last 15 months.

Few of the clinics are said to be operating profitably. Health financial experts estimate that a clinic will have to be open about 3 years before it becomes profitable.

About one in five of the clinic customers pay by cash, and Wal-Mart estimates that 55% if the clinic customers do not have health insurance.

Most of the clinics are headed by nurse practitioners who are limited to providing routine medical care, but a few of the clinics do have medical doctors present at varying times during the day.

(1/29/08)- In 2006, when Wal-Mart first announced it would be selling hundreds of generic prescription drugs for $4, the plan was aimed at people who did not have drug coverage plans. The company currently offers more than 350 generic prescriptions for $4. Other retailers were forced to match Wal-Mart's offer.

In a speech before 7,000 Wal-Mart store managers, Chief Executive Lee Scott indicated that the company was initiating a pilot program to help "select employers…manage how they process and pay prescription claims." For more on this topic please see our article Medicare and the Cost of Prescription Drugs - HMOs and Pharmacy Benefits Managers (PBMs) --Part III and also Drug Stores Low Cost Prescription Drug Coverage Plans

It seems therefore that Wal-Mart is putting its toes gently into the prescription benefits management (PBM) business.

(9/23/07)- The Wal-Mart Stores Inc., headquartered in Bentonville, Ark., the nation's largest private employee with over one million workers, announced some revisions to its employee health-care coverage plan starting next year, that may become the tinplate for many other health care plans for the nations largest companies.

According to the latest figures available, the company has 636,000 workers who received their health care coverage through the company, while 125,000 of its workers do not have their coverage through Wal-Mart.

Employees eligible for coverage will have the ability to choose from over 50 ways to customize their coverage to their own needs. The lowest premium option will cost $8 per month and will have a $2,000 deductible for those employees who need the least amount of medical coverage. On the other hand the most expensive of the options will have a monthly premium of $94.11 and a deductible of $350. The premiums may even be lower in some areas of the country.

The new plan will eliminate several restrictions from the prior company plan. This includes scrapping an additional deductible of $1,000 for inpatient hospital stays and $500 for outpatient surgical visits. The company will also eliminate the extra fee for spouses enrolled in a Wal-Mart plan who might otherwise be covered by their own employers.

The company helped pioneer a low-premium, high deductible coverage plan in the retail industry last year by introducing a plan with a $1,000 deductible in exchange for monthly premiums as low as $11. About 75% of retailers in the U.S. offer a preferred-provider organization with deductibles ranging from $250 to $300 as their primary option for employees, according to Hay Group, a management consulting firm.

A new option under next year's plan is one in which the employees can elect to pay higher premiums to receive health-care "credits" of $100, $250 or $500 that they can use to pay for covered medical expenses before their deductible applies. Employees enrolled in the plan can get prescriptions to any of 2,400 generic drugs for $4. This is about 1,000 more than the company sells under its drug care plan to its customers.

Brand name drugs will cost $30 to $50. About 40% of the company's workers receive their coverage elsewhere, i.e., through a spouse, a parent, a second job or a state program like Medicaid. About 10% have no coverage.

Full-time Wal-Mart employees must wait six months to qualify for coverage; part-timers will have to wait one year for coverage. The company's plan will emphasize preventive care, paid for by the company before a deductible will kick in. Health-care credits would make it possible for employees to see doctors and by prescription drugs without incurring out-of-pocket expenses.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home

Allan Rubin
updated August 15, 2014

http://www.therubins.com

To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com

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