Pharmacy Innovation Series: Exploring Integration of Primary Care Services, Telehealth, and Telepharmacy for Pharmacies of all Sizes
Note: This post is first in a series of posts exploring partnership and technology opportunities for pharmacies. Starting with an overview of the recent Walgreens/VillageMD partnership, we’ll cover everything from integration to regulatory issues to technology to business models for pharmacies of all sizes so you can better understand your options.
Recently, Walgreens announced plans to open 500 to 700 primary care clinics across the United States over the next 5 years in partnership with VillageMD, a value-based primary care company.
Bolstered by positive patient experience reviews following a successful trial in Houston, Texas last year, Walgreens will be the first national pharmacy chain to offer full-service primary care at its stores.
Further, more than 50 percent of the clinics, which will be co-located in Walgreens stores and called “Village Medical at Walgreens,” will be located in medically underserved and rural areas. Through these clinics, Walgreens will offer increased access to a unique model of physician-led, value-based primary care to those communities who currently have limited access to such services.
Village Medical will operate under an integrated pharmacy and primary care model, offering a broad range of services, such as preventative visits and chronic disease management. The model is expected to produce two key outcomes: (a) improved patient outcomes through increased medication adherence, and (b) increased revenue.
Walgreens’ partnership with VillageMD is an emerging a trend in integrated pharmacy with healthcare delivery that we are likely to see proliferate. CVS launched HealthHubs—which are a sort of second generation of their Minute Clinics—soon after the initial Walgreens/VillageMD pilot of the Village Medical Model. Rite Aid is not far behind, having announced at this year’s HLTH VRTL conference that they plan to completely overhaul their stores to include patient-centered wellness model that integrates pharmacy and clinical care services. I predict we will see emerging partnerships among independent pharmacies, primary care providers, and digital health companies in the marketplace.
WHAT MAKES THIS MODEL UNIQUE?
The Walgreens/VillageMD model serves as an example for the future of pharmacy integration. Customers will have access to a one-stop shop for primary care services and prescription management in-store. In addition to the services highlighted above, which focus on improving healthcare outcomes through preventative and coordinated care, Walgreens customers will also have 24/7 access to telehealth and at-home visits. Walgreens’ healthcare marketplace website/app, Find Care, will serve as the online platform supporting telehealth visits. The remote capabilities are likely to be especially helpful for alleviating travel and transportation challenges which have been further exacerbated by the global pandemic.
TELEHEALTH AND TELEPHARMACY
By partnering with primary care providers, pharmacies are likely to become more central to the delivery of primary care. As patients begin to expend on-demand, remote patient care, the delivery of pharmacy services is likely to become virtual as well. The Walgreens model lends itself to the delivery of both telehealth and telepharmacy services. Telepharmacy is the practice of pharmacy at a distance, through the use of telecommunication technology. As payors begin to fully appreciate the role of the pharmacy in the management of chronic conditions and preventive care, both pharmacy integration and implementation of telepharmacy is increasing. So, what does telepharmacy integrated care look like in practice?
Patient A visits (or televisits!) her primary care physician (PCP). Her physician sends an electronic prescription to the pharmacy. A telepharmacy technician sends images of the prescription, label, drug, and container/bottle to the pharmacist through the telecommunications system for review. The telepharmacist reviews the prescription and the patient's medical profile to identify any potential contraindications that may warrant contacting the PCP. If the telepharmacist determines the prescription is appropriate, she approves dispensing the drug and the telepharmacy technician then coordinates delivering such prescription to the patient. The patient can also receive follow up remote counseling from the pharmacist through real-time audio-video.
IS THIS MODEL FOR LARGE PHARMACY CHAINS ONLY?
Walgreens will invest $1 billion in VillageMD over the next three years—funds that will be used to fund opening the new clinics and integrating their services digitally with Walgreens’ pharmacy services. In Spring 2020, Rite Aid executives stated that the chain would invest $700 million in its rebrand and relaunch. CVS is likely to invest at least as much as they launch an projects 1,300 locations by the end of 2021. However, independent pharmacies and smaller chains have plenty of opportunity to implement similar customer offerings, if they’re willing to take the leap.
As with other industries, such as online grocery shopping and curb-side pickup at restaurants, the remote healthcare industry is becoming increasingly popular as the COVID-19 pandemic continues. Many consumers have found these options to not only be a safer way to participate in their daily activities, but also a more convenient way. Similarly, patients are experiencing shorter wait times and more efficient healthcare visits by receiving telemedicine and telepharmacy services instead of in-person care. As such, telepharmacy services are likely to become the preferred delivery method for pharmacy services, especially for high-risk patients who may not be comfortable engaging with the rest of the community, even after the pandemic subsides. I predict that more pharmacies will likely begin to explore offering telepharmacy services as a way of adding more value to patients as they transition to seeking more virtual care services.
HOW CAN MY PHARMACY IMPLEMENT AN INTEGRATED CARE MODEL?
At its most basic levels, integrated care requires careful structuring of relationships between healthcare providers and pharmacies. Collaborations between healthcare providers and pharmacies are complex from a regulatory perspective, and could implicate federal and state kickback and self-referral laws. In my next article, I will explore this a bit further. Telepharmacy requires an additional layer—the selection and implementation of secure technology that enables remote communication with patients.
Pharmacies who may not have an enormous amount of capital to invest in a model to partner with a primary care provider, as Walgreens did with VillageMD, may see this model as out of reach; however, a thorough analysis of the business model from a revenue and regulatory perspective may be a good start for any pharmacy considering expanding their services offerings to include primary care, or even telepharmacy. The model can be implemented at varying budgets, depending on scope and complexity.
WHAT IS YOUR NEXT STEP?
Now that we’ve covered the basics of integrated pharmacy services and telepharmacy, it’s time to help you evaluate how you can evaluate whether these innovations might make sense for your business.
In future posts in this series, we’ll cover the complex regulations surrounding these types of integrations—specifically federal and state kickback and self-referral laws, federal and state requirements surrounding telepharmacy, and what unique services pharmacies can add to their business model to appeal to the current generation of consumers.
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