Oregon’s largest Medicaid provider, CareOregon, announced this week that it has purchased an old Red Lion Inn in Seaside for $8 million.
The hotel will be turned into housing for two different populations: there will be units for people with behavioral health needs and workforce housing for health care professionals.
CareOregon, the state’s largest Medicaid provider, has purchased a former Red Lion Hotel in Seaside with the goal of turning it into both workforce housing and permanent supportive housing for people with behavioral health needs.
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CareOregon’s Columbia Pacific Coordinated Care Organization will run the building in partnership with Clatsop Behavioral Health.
“There’s no question about that and the shortage of housing on the North Coast is acute,” said Mimi Haley, executive director of Columbia Pacific CCO. “Being able to solve the housing shortage issue by adding these 50 or 60 new apartments is a big deal.”
Clatsop County has the highest per capita homelessness rate in the state, and Haley pointed out that finding housing for this population could also improve their health outcomes.
“People who are unhappily housed have much higher rates of hospitalizations for situations that could have been handled in primary care,” said Haley. “They have much lower rates of engagement with the primary care system. They will often pass away at a much younger age, and they often have mental illnesses or substance use disorders that can’t be really addressed without stable housing.”
The facility will be staffed by people who have lived experience with homelessness or behavioral health issues 16 hours a day, seven days a week. There will also be a live-in resident manager who’s there 24/7.
Forty of the hotel rooms will be converted into permanent supportive housing for people with behavioral health needs, such as treatment for substance use disorder. The remaining 20 units will be turned into housing for another population that has had difficulty finding housing on the coast: healthcare professionals.
Amy Baker, the executive director of Clatsop Behavioral Health, says the agency has lost multiple employees who were unable to find housing.
“We actually rented a cottage so that we could relocate folks into that cottage while they tried to find more permanent housing,” said Baker. “Unfortunately, that one cottage isn’t even nearly enough.”
Haley hopes these units begin to address some of the challenges providers across Clatsop County have been experiencing with recruitment and retention.
“We know from our partners that they cannot recruit the providers that they need,” she said.. “We hear it all the time from all of our partners across all provider levels and types.”
The old hotel should start getting a makeover sometime this year, and Haley hopes it will be ready to open in spring of next year.
“The piece that gives me hope and faith is that you go into this work because you care about people,” said Baker, “and ultimately having a place for somebody to live, it’s just a good thing.”
Shock clinical costs are nothing at all new in the U.S., and they have come to be so commonplace in the 13 a long time since the landmark Cost-effective Treatment Act (ACA) became law that Congress lately passed laws aimed at banning the observe.
Occasionally a simple coding mishap can end result in a main headache for a client, as was the situation for Anthony, a 29-year-aged based mostly out of Norwalk, Conn.
When Anthony frequented his doctor for a regime yearly checkup — which his insurance policies system as a result of Cigna marketed as 100{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} included with no a copay — he finished up getting a monthly bill for $132.09.
This was simply because his doctor’s business coded the take a look at as an “office visit” instead of an “annual checkup or preventative care.” In an effort and hard work to distinct up the confusion, Anthony identified as both of those Cigna and his doctor’s office environment, and Cigna confident him that it was just detailed underneath the wrong code and would be protected if the doctor’s billing department corrected it.
“I submitted a grievance to Westmed, and they forwarded it to the billing section,” Anthony explained to Yahoo Finance. “They turned down my ask for a number of occasions. In accordance to them, the place of work staff members experienced the ultimate phrase on the billing code. I was able to converse to the office environment staff members specifically also, but I’m not absolutely sure who was responsible for selecting the billing code there.”
Healthcare Radiology Manipulator Ludovic Foy prepares a lady before her lung cancer screening on December 16, 2021. (Image by Pascal POCHARD-CASABIANCA/AFP)
The expertise, he added, has been “really disheartening” and time-consuming, particularly just after he achieved out to numerous offices to consider to remedy the challenge.
“Wasted a bunch of time, and, frankly, I obtained cheated,” Anthony said. “In the close, I received no explanation why they employed the mistaken code, and the invoice was despatched to collections. It’s heading to harm my credit score rating and in the U.S., that also suggests my potential to obtain a location to hire or even buy a home if I ever get the opportunity. It’s the sort of factor you get rid of slumber around.”
‘They consider shorter-term’
A loophole in the ACA — frequently identified as Obamacare — is element of the motive why this problem persists in the U.S.
Less than the ACA, insurers are needed to cover preventive solutions these kinds of as cancer screenings, immunizations, and effectively-girl visits without having price-sharing, which means that the particular person receiving the providers is not essential to pay anything at all.
A research published in 2021 in the journal Preventive Medication discovered that “in addition to premium charges intended to deal with preventive treatment, Us residents with employer-sponsored coverage were being nevertheless billed involving $75 million and $219 million in total for services that should to be totally free to them.”
In this March 23, 2010 picture, President Barack Obama indicators the Affordable Treatment Act in the East Room of the White Dwelling in Washington. (AP Picture/J. Scott Applewhite, File)
“The ACA specified these procedures about what should be included, but then how that is essentially operationalized is remaining up to person insurers — what method codes are included under the umbrella of every of those products and services in same or spirit, who qualifies, how normally they can get them is up to each individual insurer,” Paul Shafer, assistant professor of wellbeing, legislation coverage, and administration at Boston College School of Public Overall health, advised Yahoo Finance.
In addition, last September, Decide Reed O’Connor — who formerly ruled that the ACA was unconstitutional, a final decision that was later overturned by the Supreme Courtroom — issued a ruling that it was also unconstitutional for the ACA to demand insurers to include preventive services without the need of copayments.
If that ruling had been to stand, at least 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of grown ups indicated in a new Early morning Seek the advice of study that they would not be keen to pay out for a the greater part of the preventive solutions lined by the ACA mandate.
Even though the primary purpose of preventive visits is to reduce more time-expression difficulties from arising down the line — thus getting rid of likely expenses — insurers never usually see it that way, particularly if a service provider lists a various code on a patient’s file.
“They think brief-time period — and I’m talking in specific about the publicly-traded providers,” Wendell Potter, president of the Center for Well being and Democracy and previous executive at Cigna and Humana, advised Yahoo Finance. “They’re the types who are dominant in this location. They know there is a excellent likelihood that a man or woman who’s enrolled in a Cigna strategy now may well in the next 50 percent of this 12 months be enrolled in a United strategy, or even up coming thirty day period could be enrolled in a United strategy or a Humana approach. Persons alter work opportunities, and when they adjust positions, that usually necessitates that they have to get the job done with a new carrier with a new community of health professionals. And all of that goes with that.”
Fundamentally, insurance policy corporations increase by having current market share from each and every other, and Potter and other business industry experts refer to this as “churn.”
Former CIGNA executive Wendell Potter moderates a discussion board on denied coverage by coverage organizations March 10, 2010 in Washington, DC. (Picture by Alex Wong/Getty Photographs)
Therefore, Potter claimed, “they decide on to have a limited-expression target and don’t have the fascination truly in carrying out what is correct for anyone down the road mainly because they are just earning a guess that they very likely will not have that person enrolled for a lengthy period of time of time.”
The No Surprises Act, which became regulation in 2021, was intended to protect against sufferers from obtaining surprise medical charges. However, it also will come with one more loophole: The law safeguards people getting treatment from out-of-network suppliers and out-of-network crisis companies, but it isn’t going to utilize in instances where by the treatment is getting supplied by in-community vendors, irrespective of regardless of whether or not it ought to be free for the individual.
“Policymakers and employers and the media, to a large extent, are missing some essential parts of our well being care system that want a lot more scrutiny,” Potter claimed. “We are really focusing on a handful of precise parts exactly where individuals in unique are at a good downside. Increasingly, this is an area wherever we find people today are owning difficulties when there is a dispute or glitch in refusing to fork out a declare.”
Not-so-cost-free treatments
Simply because of these loopholes, sufferers normally come across on their own billed for routine techniques that commonly are totally covered by their health insurance plan.
Various people, who questioned to continue being unnamed due to privacy worries, shared with Yahoo Finance the types they ended up expected to signal in buy to be noticed for regime physicals and other preventive exams.
In a single of the types, an unique was instructed that if they talked over any new or long-term health care difficulties with their health practitioner, their insurance policies would be billed for each an place of work take a look at and a preventive wellbeing examination.
For another specific, their form indicated that if they discussed new acute disorders or a worsening chronic ailment, if a diagnostic take a look at was requested, or if a remedy modified, they would also be matter to two separate bills.
“There are a large amount of gray places but usually, individuals should not be billed,” Jenifer Bosco, a employees lawyer at the Countrywide Buyer Law Center, informed Yahoo Finance. “In the worst situation, some companies do engage in what’s referred to as upcoding where they will try out to invoice for factors or get reimbursed at a substantial amount for factors that actually need to be possibly preventive or should really be billed at a lower fee.”
For case in point, a preventive colonoscopy meant to monitor for most cancers is required to be protected at 100{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} by overall health coverage companies. Nevertheless, if a polyp is discovered and eliminated from the individual throughout that screening, that method turns into a “surgery” somewhat than a screening and is billed as such.
“It can make zero sense charging the expense of some thing or the value to the individual for a little something when they’re practically mid-method,” Bosco explained. “You can basically monthly bill two visits for the very same time, which I imagine intuitively just does not make a lot of sense to most folks. If you’re likely in for one particular check out, how can you be billed for two and also be losing that cost-free preventive pay a visit to at the very same time?”
According to the Preventive Medicine analyze, patients had been saddled with a complete of $12.8 million for preventive colorectal screenings in 2018, though wellness visits incurred expenses of up to $73.1 million.
“It feels a minor little bit like a bait and swap, and that’s not on the medical doctors,” Shafer said. “That’s just how we’ve established up the reimbursement guidelines and every little thing else. It is disheartening.”
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Adriana Belmonte is a reporter and editor masking politics and wellbeing care plan for Yahoo Finance. You can comply with her on Twitter @adrianambells and access her at adriana@yahoofinance.com.
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BRYAN, Texas (KBTX) -Brazos County veterans weighed in on the top quality of their overall health care and what they’d like to see adjust throughout a city corridor meeting Saturday.
The celebration was hosted by the American Legion Article 159 in Bryan and the Brazos County Veteran Services Workplace.
The town Hall was moderated by Michael Kiefer, Director of the Central Texas Veterans Wellness Care Program.
Health professionals, assert specialists, and other reps from the Texas Central VA Overall health Treatment Process, Bryan-School Station VA Clinic have been existing at a town corridor conference. They explained modern improvements and improvements to VA health care and dealt with veterans’ concerns in both group and 1-on-just one settings.
“I just desired to appear out and greet our veterans who wanted to occur out and greet us,” Kiefer claims. “I think veterans react to that individual conversation instead than just undertaking items remotely or via social media.”
At the city corridor, every single topic was open for dialogue, but there was a significant emphasis on informing veterans about neighborhood treatment. This program aims to make improvements to health care in rural communities, like Bryan-higher education station, in which the nearest VA medical center is more than an hour away.
“Since we are remote, a very long way from the VA Hospital we’re really heading to use the services around Bryan-College Station for specialty care,” states Alfred Paterson, Brazos County Veterans Company Officer.
According to the Veterans Administration, the Veterans Neighborhood Care Program (VCCP) provides eligible veterans with the alternative to acquire healthcare companies from a regional group health care company, based mostly on their health care prerequisites and eligibility requirements. Nevertheless, veterans can still select to receive health care products and services from a VA clinical facility. To avoid being charged for group treatment, VA approval is essential for most circumstances. VA staff associates are dependable for deciding eligibility for group care.
Paterson states having the more care options locally will be useful for veterans, their family members, and caregivers.
“It’s so considerably easier to go 15 minutes to your doctor’s pay a visit to at Baylor Scott & White or St. Joseph as opposed to using an complete day to go up to Temple,” said Patterson. “if a veteran for example, an aged veteran who has a back again issue for him or her to travel an hour and fifty percent just one way to Temple is hard.”
Central TX VA officials and Brazos County Veterans collected at a city corridor to explore health care issues and advancements. Michael Kiefer, Director of the Central TX Veterans Well being Care Method, answered veterans’ issues. Tune in to News 3 at 10 for far more. #VeteransHealthcarepic.twitter.com/imVNgn2Y8C
Brazos County Veterans Company Business 200 South Texas Avenue, Suite 167, Bryan, TX 77803 Mobile phone: (979) 361-4360 Email: apatterson@brazoscountytx.gov
Burleson County Veterans Support Officer Franklin Karasek 100 W. Buck, Suite 104, Caldwell, TX 77836 Cellphone: 979-567-6360
Madison County Veterans Assistance Officer 101 West Main, Suite 115, Madisonville, TX 77864 Mobile phone: 936-348-2244 Email: erica.greene@madisoncountytx.org
Robertson County Veterans Assistance Officer Paul Baker 209 Cedar Street, Hearne, TX 77859 Cellphone: 979-280-5994
Leon County Veterans Services Officer Kimberly Cervantes 113 West Primary, Annex I, 2nd Flooring, PO Box 429, Centerville, TX 75833 Mobile phone: 903-536-3666 E mail: vso@co.leon.tx.us
Washington County Veterans Support Officer Eric Posern Washington County Courthouse Annex, 105 W. Major Road, Suite 102, Brenham, TX 77833 Cellphone: (979) 277-6228
Grimes County Veterans’ Expert services Officer Jay Lafferty 270 FM 149 W. (located in the Grimes County Justice & Business enterprise Heart upcoming to the Sheriff’s Section), PO Box 811, Anderson, TX 77830 Cellular phone: (936) 873-4490
CHARLESTON, W.Va. — West Virginia’s Republican supermajority Senate followed a growing national trend of GOP opposition to health care for transgender youth by passing a bill that would ban certain treatments and therapies, while approving a significant change to add exceptions for mental health.
The Senate version of the bill passed by a count of 30-2 on Friday was noteworthy in the addition of allowances for some transgender youth to continue receiving medical interventions, including hormone therapy, when they are considered at risk of self harm or suicide.
The bill faces steep opposition in the state House of Delegates, which will take up the amended Senate version. The GOP-dominated House last month passed a proposal including a ban on puberty-blocking medication and hormone therapy, with no exemptions for mental health.
Republican Gov. Jim Justice has not taken a public stance on the measure.
Lawmakers in West Virginia and other states advancing bans on transgender health care for youth and young adults often characterize gender-affirming treatments as medically unproven, potentially dangerous in the long term and a symptom of “woke” culture.
Every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, supports gender-affirming care for youths.
The West Virginia Senate bill passed Friday would outlaw those under 18 from being prescribed hormone therapy and fully reversible medication suspending the physical changes of puberty, buying patients and parents time to make future decisions about hormones.
“These kids struggle, they have incredible difficulties,” said Majority Leader Tom Takubo, a pulmonologist, who urged support for mental health protections.
Takubo’s approved change would allow young people to access puberty blockers and hormone therapy if they are experiencing severe gender dysphoria, under certain circumstances.
Gender dysphoria is defined by medical professionals as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.
The rate of suicide ideation for transgender youth in Virginia is three times higher than the rate for all youth in the state, according to research and data complied by WVU Medicine physicians using the West Virginia Youth Risk Behavior Survey.
During a speech on the Senate floor, Takubo referenced 17 peer-reviewed studies showing a significant decrease in the rates of suicide ideation and suicide attempts among youth with severe gender dysphoria who have access to medication therapy.
He found a supporter in Senate Health and Human Resources Committee Chair Sen. Mike Maroney, another trained physician, who said lawmakers would set “a dangerous precedent” by disregarding medical research in favor of political gain.
“Who are we, to win an election, to tell people how to practice medicine? To change treatments? It’s unbelievable,” the Republican said, adding that lawmakers wouldn’t apply the same standard for drugs for cancer or mental illness.
The legislation also includes a ban on gender-affirming surgery for minors, something medical professionals emphasize does not happen in West Virginia.
During Friday’s debate, Republican Sen. Eric Tarr repeated those concerns, saying the medical interventions doctors are practicing are too extreme and driven by “woke” culture.
“They’re trying to take pronouns out of our textbooks for kids,” Tarr said.
With Takubo’s change, a person under 18 would have to be diagnosed with severe gender dysphoria by at least two medical or mental health providers to access medication therapy. One would have to be a mental health provider or adolescent medicine specialist.
The dosage must be the lowest possible necessary to “treat the psychiatric condition and not for purposes of gender alteration,” according to the bill.
The providers must be specifically trained to diagnose and treat severe gender dysphoria in adolescents and would have to provide written testimony that medical interventions are necessary to prevent or limit self-harm or the possibility of self-harm.
The minor’s parents and guardians also would be required to give written consent to the treatments.
Hormonal therapy could not be provided to minors before the age of puberty, something West Virginia physicians say doesn’t happen anyway.
The House version of the bill passed last month 84-10, with all ‘no’ votes coming from the body’s shrinking delegation of Democrats. They accused GOP lawmakers of putting children’s lives at risk to score political points with the national conservative movement.
That version provides exceptions for individuals born with a “medically verifiable disorder” including people with “external biological sex characteristics that are irresolvably ambiguous” and for people taking treatments for infection, injury, disease, or disorder that has been “caused by or exacerbated by the performance of gender transition procedures.”
People also can access the treatment if they are in “imminent danger of death, or impairment of a major bodily function unless surgery is performed.”
Speaking against Takubo’s amendment Friday, Republican Sen. Mark Maynard said he didn’t see why any changes were necessary. He worried additions could make the state vulnerable to a lawsuit.
“This amendment would disintegrate the clarity of the bill in its very simple terms,” Maynard said. “These guardrails are already in this bill as it came to us from the House.”
The vote came a day after a crowd of protesters descended on the state Capitol, where cries of “trans kids matter” could be heard from the Senate chamber as lawmakers debated bills.
Democratic Del. Danielle Walker, the only openly LGBTQ member, led chants of the state motto: “Mountaineers are always free.”
“They are trying to come for trans kids in West Virginia, and they’re going to come for every single one of us next,” said Sam Green of Huntington, wearing a transgender pride flag draped around their shoulders while addressing the crowd.
Cecelia Moran, an 18-year-old high school student from Marion County, said she feared banning any kind of medically proven health care could result in more young people leaving West Virginia, one of only three states to lose population in the 2020 U.S. Census.
“I think a lot of young people already struggle to stay here and feel welcome here and are already planning on getting out of the state as soon as possible,” she said.
Her mother, Rebecca Moran, said the bill is “just completely unnecessary” and decisions about healthcare should be made by families and health care providers.
“This is not what’s harming our kids,” said Rebecca Moran, a city councilor in Fairmont. “There’s so many other things: homelessness, poverty.”
Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.
Stephanie Colombini/WUSF
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Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.
Stephanie Colombini/WUSF
At a health-screening event in Sarasota, Florida, people milled around a parking lot waiting their turn for blood pressure or diabetes checks. The event was held in Sarasota’s Newtown neighborhood, a historically Black community.
Local resident Tracy Green, 54, joined the line outside a pink and white bus offering free mammograms.
“It’s a blessing, because some people, like me, are not fortunate and so this is what I needed,” she said.
Green said she wanted the exam because cancer runs in her family. And there’s another health concern: her breasts are large and cause her severe back pain. A doctor once recommended she get reduction surgery, she said, but she’s uninsured and can’t afford it.
In a recent Gallup poll, 38{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of Americans surveyed said they had put off medical treatment last year due to cost, up from 26{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.
A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor’s office visits. Many didn’t take medications as prescribed.
The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.
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The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.
Stephanie Colombini/WUSF
The neighborhood screening event in Newtown — organized by the non-profit Multicultural Health Institute in partnership with a local hospital and other health groups — is part of an effort to fill in the coverage gap for low-income people.
Tracy Green explained that her teeth are in bad shape too, but dental care will also have to wait. She doesn’t have health insurance or a stable job. When she can, she finds occasional work as a day laborer through a local temp office.
“I only make like $60 or $70-something a day. You know that ain’t making no money,” said Green. “And some days you go in and they don’t have work.”
If she lived in another state, Green might have been able to enroll in Medicaid. But Florida is one of eleven remaining states that haven’t expanded the program to cover more working-age adults. With rent and other bills to pay, Green says her health is taking a backseat.
“I don’t have money to go to the dentist, nothing, it’s so expensive,” she said. “Now, to get one extraction, one tooth pulled, it’s like $200-300 that you don’t have. So I don’t know what to do. It’s like fighting a losing battle right now.”
Tracy Green, 54, joined the line outside a pink and white bus that offered free mammograms. Green said she wanted the exam because cancer runs in her family.
Stephanie Colombini/WUSF
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Stephanie Colombini/WUSF
Tracy Green, 54, joined the line outside a pink and white bus that offered free mammograms. Green said she wanted the exam because cancer runs in her family.
Stephanie Colombini/WUSF
In the Kaiser poll, 85 percent of uninsured adults said they found it difficult to pay for health care. Nearly half of insured respondents said they struggled with affordability as well.
The U.S. experienced record high inflation rates last year, and parts of Florida, including the nearby Tampa metro area, often fared even worse.
“We see an increasing desperation,” said Dr. Lisa Merritt, executive director of the Multicultural Health Institute.
The Institute, which helps people access low-cost care, is based in Newtown. The neighborhood, inland from Sarasota’s lavish beach communities, has many residents who live below the poverty line, lack insurance and face other barriers to consistent and affordable care.
“It’s very difficult for people to be concerned about abstract things like getting screenings, getting regular health maintenance, when they’re contending with the challenges of basic survival: food, shelter, transportation often,” Merritt said.
‘Horrible’ housing costs put squeeze on health needs
Merritt and her team of volunteers work to build trust with community residents who may not be aware that support is available. They help people apply for low-cost insurance coverage, free medication programs and other resources that can reduce treatment costs.
Volunteer Bonnie Hardy said the people she serves have many financial worries, but one thing tops the list.
“Right now? A place to stay,” said Hardy. “Housing is horrible.”
High housing costs have started to ease in recent months, but data shows rent in Sarasota has gone up nearly 50 percent since the pandemic began in 2020.
Hardy helps people find housing and connects them with programs that cover costs like utilities and security deposits. The goal is to help people stabilize their day-to-day lives, and that in itself can improve health, she said.
“Because they’re more comfortable now,” she said. “They feel like, hey the rent is paid, I can let my guard down, maybe I can go get the medical attention I need.”
Dr. Lisa Merritt and her team of volunteers work to build trust with community residents who are uninsured but may not be aware that support is available.
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Dr. Lisa Merritt and her team of volunteers work to build trust with community residents who are uninsured but may not be aware that support is available.
Daylina Miller/WUSF
Research shows putting off health care can lead to bigger problems.
The Gallup poll found 27{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of respondents delayed treatment due to costs even for “very or somewhat serious” conditions.
Another reason people may be holding off on treating medical issues is that they already have health care debt. An investigation from NPR and Kaiser Health News found about 100 million people in America had medical debt. About 1 in 8 owe more than $10,000, according to a KFF poll.
Treating cancers or chronic conditions like diabetes early can not only save lives, it can also be less expensive than treating advanced-stage illnesses, according to the Centers for Disease Control and Prevention.
Doctors at the health screening event in Newtown said it’s critical to help residents access preventive care.
At the health fair, substitute teacher Crystal Clyburn, 51, got a mammogram on the pink-and-white mobile bus and had her blood pressure checked. Clyburn doesn’t have health insurance and she relies on events like this to stay on top of her health.
“I just try to take advantage of whatever that’s out there, whatever that’s free,” she said. “You have to take care of yourself because you can look healthy and not even know you’re sick.”
After the cuff came off, a doctor told Clyburn her blood pressure was a little high. But then the doctor kept talking, and she smiled.
Although her pressure was high, it wasn’t high enough that she needed to take medication. She thanked him and left, relieved to know that was one expense she wouldn’t have to worry about. Not yet, anyway.
Amazon, Walmart, CVS, Dollar General and other big retailers are elbowing their way into health care delivery, pushing a customized consumer experience driven by digital health products.
What’s happening: At its core, these companies are pulling together different tech-enabled services — urgent, primary, home and specialty care, pharmacy, and, in some cases, full integration with an insurer.
“Convenience is really front and center to those plays. They are trying to capture the attention of the patient when they already own that consumer,” Caroline Hofmann, head of emerging businesses at virtual specialty care company Thirty Madison.
Why it matters: A more user-friendly portal to the health system could lead to more engaged patients and better access to care in underserved areas. It could even yield a sustainable model for profitably offering better care for less money.
But the retailers’ forays are prompting growing anti-trust and privacy concerns, as well as fears of further erosion of the doctor-patient relationship once considered central to coordinated care.
What they are saying: “If you fast forward 10 years from now, people are not going to believe how primary care was administered,” said Amazon CEO Andy Jassy in a recent announcement about the company’s $3.9 billion acquisition of concierge medicine provider One Medical.
With that deal, which closed last month, Amazon brought in an on-demand virtual care services platform, more than 125 locations and a piece of the Medicare Advantage business.
Driving the news: Yesterday, Best Buy Health launched a hospital-at-homeprogram with North Carolina-based Atrium Health. The tech retailer bought the remote patient monitoring company Current Health in 2021. Best Buy said it will provide patient education, its at-home care platform and devices, and technical support via specially-trained Geek Squad agents.
It came on the heels of Walmart Health announcing last week that it plans to nearly double the footprint of its in-store clinics, which offer primary, behavioral health vision and dental care. In the fall, Walmart also inked a 10-year Medicare Advantage deal with UnitedHealth Group.
In January, CVS Health announced a plan to buy Oak Street Health, a primary care group focused on Medicare patients. The pharmacy giant already owns insurer Aetna, pharmacy benefit manager CVS-Caremark, home health company Signify Health and health care service brands MinuteClinic and HealthHUB.
Between the lines: Amazon, CVS and Walmart have made some of the most consequential moves by combining their massive retail footprints with assets like primary or urgent care sites, pharmacies and some sort of relationship with insurers, experts say.
“They’re all acquiring every piece of medicine,” Robert Pearl, a Stanford University professor and former CEO of The Permanente Medical Group, told Axios.
“Medicine as we know it will be very very different assuming they’re successful. They’re big companies, they’re smart companies.”
Be smart: Depending on the retailer, patients might have access to virtual care services, book appointments and fill prescriptions via an app.
They could get same-day care, get preventative services like vaccines and pick up their drugs in-store. A health worker might walk them down store aisles and guide them to healthy food purchases and wellness products.
In the first wave of this trend, retailers were more focused on urgent care or one-off visits for vaccines, said Jacob Effron, a principal at Redpoint Ventures.
“The criticism that could’ve been levied at that is that patients could just go for that ad hoc care and not have an ongoing relationship with a primary care doctor,” he said.
In recent months, retailers are investing in end-to-end primary care. “That’s what gets me increasingly excited about their role because there’s only so much you can do as the urgent care provider and much much more you can do when you have that longitudinal relationship between the doctor and a patient over time,” Effron said.
Between the lines: Each of these businesses also are clearly eyeing a very lucrative segment of health care: Medicare Advantage. More than half of eligible seniors are now covered by privately-run Medicare.
Medicare Advantage is attractive because its payment models are geared toward rewarding providers for wellness and prevention care. Payments are capped so there’s an incentive to use integrated care to keep people healthy rather than providing services when they are sick.
For some retailers, it’s similar to the Kaiser Permanente model, where the payer and provider are completely aligned, Pearl said. But the retailers could create an HMO on steroids.
“Why has Kaiser Permanente never really expanded nationally? It’s very hard to get enough of a population in a local area to provide it. You can’t hire enough specialists, enough doctors,” he said. “The beauty of the retail giants is how big they are. If you get every Amazon Prime member to join, they immediately have enough volume they need to put in place a high-functioning system.”
What to watch: How these businesses evolve.
Amazon until now has been mostly virtual in its offerings, Effron said. “It begs the question, will they do a similar model to what some of these others have done and put clinics in Whole Foods?”
The bottom line: This still makes up a very small segment of health care delivery — and may not solve the medical system’s biggest problems.
“These players ultimately have to deliver the same or better outcomes at a lower cost in order to be in-network and get recommended by payers as well as picked by the employers,” Hofmann said.
And, she said, they can certainly increase access. “It remains to be seen if they can really bend the cost curve,” she said.
Editor’s note:This story has been updated to correct the spelling of Caroline Hofmann’s name.
