CVS Health Rolls Out Virtual Primary Care Service

Aetna launching nationwide virtual primary care solution | Fierce HealthcareSource: Fierce Healthcare, by Heather Landi

Retail drugstore giant CVS is rolling out a virtual care service that gives consumers access to primary care, on-demand care, chronic condition management and mental health services.

 

Eligible Aetna and CVS Caremark members will be able to use the virtual primary care service to access healthcare services on demand, whether at home or in a retail or community-based setting. Members also will have the option of being seen in person at an in-network provider, including CVS MinuteClinic locations. The virtual primary care provider can also help members identify appropriate in-network specialists and other in-network health service providers, according to the company.

The virtual solution will roll out to Aetna members starting Jan. 1, 2023, and for eligible CVS Caremark members during the second quarter of 2023. Caremark also will introduce virtual specialty care solutions on the platform in 2023.

 
 

The CVS Health virtual primary care service complements Aetna’s virtual care strategy currently in the market, which was launched last August, according to a CVS spokesperson.

CVS Health Virtual Primary Care is a payer-agnostic solution that connects the company’s services, clinical expertise and data on a single digital platform for a more coordinated and consumer-centric experience, the spokesperson told Fierce Healthcare.

The solution features an interoperable electronic health record that can be used across CVS Health primary care’s physician-led care team and sites of care, and it includes tighter connections to CVS pharmacists. The platform is scalable and intended to evolve to include more CVS Health services.

 

“We’re meeting people where they are on their health care journey and providing care that is more convenient and easier to access. When we make it simple, we can help people lead healthier lives,” said Creagh Milford, a doctor of osteopathic medicine, vice president, enterprise virtual care at CVS Health, in a statement.

On average, it takes 24 days to schedule an appointment with a primary care physician, and the average wait time to see a mental health provider in-person is 48 days, according to CVS executives.

The virtual primary care service will feature a member-selected physician-led care team that can consist of nurse practitioners, registered nurses and licensed vocational nurses. The care team will consult with a dedicated CVS pharmacist when needed, which can provide opportunities for medication management, the company said.

By leveraging an interoperable electronic health record, Aetna and CVS Caremark members can transition between virtual and in-person care, and clinical data can also be shared with their other providers.

 

“By offering a connected care team where providers can easily exchange clinical information on behalf of their patients, and an extensive local footprint for in-person care follow-up, we’re able to provide consistent, high-quality care. This model shifts from reactive to proactive care that can ultimately improve outcomes and help lower costs,” Milford said.

CVS is the latest healthcare player to expand or launch such a platform in an increasingly crowded primary care market.

Virtual primary care and virtual-first health plans have been a trend in the industry following an explosion in telehealth and virtual care use under the COVID-19 pandemic.

Major payers including UnitedHealthcareAnthem and Aetna have all launched virtual primary care solutions in various markets. Cigna also expanded access to virtual care through its MDLive subsidiary, including the launch of a new virtual-first health plan pilot for select employers. The insurer said the new programs are an early result of its acquisition of the telehealth company, which closed last April.

Traditional providers are now contending telehealth companies, standalone clinics, health plans and corporations like Amazon and Walmart. Last year, Walmart acquired MeMD, a multispecialty telehealth provider, in an effort to significantly expand its telehealth capabilities.

Amazon piloted its healthcare business in 2019 to provide virtual urgent care services to its employees and their families in the Seattle region. The online retail behemoth now offers its virtual primary care service, called Amazon Care, to companies and Amazon employees in all 50 states. Amazon Care also offers in-person care in cities including Seattle, Baltimore, Boston, Dallas, Austin, Los Angeles, Washington, D.C., and Arlington, Virginia, and is on track to rapidly expand its hybrid care model to more than 20 additional cities in 2022.

CVS Health has been exploring virtual care options since 2015 when its MinuteClinic locations began piloting telehealth services, according to the company.

Older Americans Oppose Approval Process for Home Care Services

Eighty-three percent of seniors oppose a Medicare policy that requires a government contractor to approve claims for physician-prescribed home health care, according to a poll sponsored by Bring The Vote Home. The Centers for Medicare & Medicaid Services (CMS) recently implemented a pre-claim review demonstration that imposes documentation requirements on home health agencies and referring physicians. Doctors have to provide a broad array of eligibility-related documentation and clinical support for review by government contractors. Home health leaders warn that the new requirements could delay care and increase healthcare costs. Seniors say that requiring a government contractor to approve home heath care will have the following results:

  • 80% say it will delay care.
  • 77% say it will increase Medicare costs.
  • 75% say that will increase out-of- pocket costs.
  • 45% say it will decrease fraudulent home health claims.

For more information, visit bringthevotehome.org.

Bill Would Eliminate Medicare Advocacy Services

The Senate Appropriations Committee recently approved the FY17 Labor, HHS, Education Appropriations bill, which would eliminate funding for the State Health Insurance Assistance Program (SHIP). It’s called the Health Insurance Counseling and Advocacy Program (HICAP) in California. It is the only program that provides free, unbiased, one-on-one Medicare coverage and benefit counseling for beneficiaries, family members, and caregivers. According to California Health Advocates, “This dangerous bill aims to eliminate this important, effective program that helps millions of beneficiaries nationwide better understand and navigate the increasingly complex Medicare program.”

More Patients Are Visiting Retail Clinics

Retail clinics are playing a growing role in health care delivery, according to a study from Walgreens. Patients are relying more on nurse practitioners at retail clinics to provide chronic and preventive health services. The study also reveals marked increases in the number of patients who are making return visits to clinics. Visits to healthcare clinics for preventive services, screening, and chronic care increased from 4% in 2007 to 17% in 2013. The annual percentage of return patient visits to Healthcare Clinic climbed from 15% in 2007 to more than 50% in 2012 and 2013. For patients age 17 and under, visits for preventive services and vaccinations increased 180% For patients ages 18 to 64, visits for health testing increased 90% while preventive health service visits increased 66%. Acute visits increased 84% for patients 65 and older. The Convenient Care Association estimates that 33% of Americans live within 10 minutes of a retail healthcare clinic. Walgreens has increased the variety of services at select Walgreens clinics from providing vaccinations to diagnosing and treating a number of chronic conditions. Clinics at select locations are open seven days a week, with extended evening and weekend hours, and offer walk-in service. Healthcare Clinics accept most major insurance plans and Medicare and Medicaid, and offer affordable, transparent pricing for those without insurance coverage. Healthcare Clinic’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90%. For more information, visitwww.walgreens.com.

Rising Costs Should Prompt LTC Conversations

The cost of long term care, which is is outpacing inflation, it creating significant financial planning challenges for the nearly 12 million Americans who need long-term care services. The cost of in-home care continues to rise, though at a more moderate rate of growth. This is good news for consumers as almost three quarters of people who need long term care prefer receiving it in their homes, according to the Genworth 2014 Cost of Care Survey. Nationally, the 2014 median hourly cost for the services of a homemaker is $19 and $19.75 for home health aide hired from a home care agency. Homemaker costs have risen 1.2% a year over the past five years. Home health aide services have risen 1.32% a year. The costs of assisted living facilities are rising much faster. The median annual cost for care in an assisted living facility is $42,000, which is an increase of 4.29% annually over the past five years. The comparable cost for a private nursing home room is $87,600, which has increased 4.19% annually over the past five years. For more information, visit www.genworth.com.

DMHC Fines Kaiser Over Access to Mental Health Services

The California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser for not providing enough access to mental health services. DMHC Director Brent Barnhart, said, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” DMHC says that Kaiser does not do the following:
• Make sure that quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
• Monitor its provider network to ensure that appointments are offered within regulatory timeframes.
• Provide effective action to improve care where deficiencies are identified.
• Provide accurate and understandable mental health education materials, including information about  the availability and optimal use of the plan’s mental health care services.

The plan’s mental health educational materials, including frequently-asked-question  sheets, Website postings, and new patient presentations included inaccurate information that could dissuade an enrollee from pursuing medically necessary care. The DMHC also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

The DMHC will conduct a follow-up survey in October to make sure that Kaiser has corrected the deficiencies and is complying with the law. The full survey report can be found here:http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bh031813.pdf.

Last Updated 08/10/2022

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