CVS Health is stationing therapists at some of its nearly 10,000 retail stores, in a move to increase patient access to often overscheduled behavioral health providers.
The services are in-network for all Aetna members, as CVS owns the insurer. The pilot program is available in a dozen stores in Houston, Philadelphia and Tampa and CVS plans to expand to 34 locations this year in communities where mental healthcare is not readily available.
The initiative represents an extension of CVS’ HealthHUBs, which exist in some 650 stores and offer urgent care services and wellness products at the same place where a consumer can fill their prescriptions. CVS was unable to immediately comment on the initiative.
The move capitalizes on CVS’ extensive retail footprint, said Adam Block, a health economist and former CMS regulator. Like CVS’ urgent care MinuteClinics, employing a licensed clinical social worker onsite also addresses a critical unmet population need, particularly as demand for mental health services rises during the COVID-19 pandemic.
“They’re really just expanding the type of healthcare that they’re already getting at their pharmacies and trying to leverage these retail properties they already have,” Block said. “There’s tons and tons of data that people trust their pharmacists and that brand value is incredibly valuable to CVS and Aetna. They’re just building on it a little bit more by expanding what they do.”
He noted that one of the most effective ways that insurers have at controlling costs is to vertically integrate their business, by adding healthcare providers who agree to payment rates that payers dictate. This strategy has been mirrored across the industry—UnitedHealth Group reportedly employs the largest provider network in the nation, with 57,000 clinicians, and Humana last week announced the close of its $8.1 billion Kindred at Home acquisition, adding some 43,000 home healthcare workers to its network.
While inpatient mental health services are one of the most expensive conditions for an insurer to treat—since individuals generally don’t fully recover but also don’t die from the disease, and their conditions often come with comorbidities—Block said this initiative could offer preventative care before more serious conditions arise, but that it was more targeted toward increasing accessibility for patients with less-critical needs.
“Insurers have found that the best way to control things is to have an ownership stake in some of the providers so that they are all working together for the same triple aim, which is cost control, clinical excellence and good customer service,” Block said. “It’s just happening in slightly different strategic ways.”
Insurers have been moving to add behavioral health services as a benefit thanks to demand from employers, who have recognized that the pandemic has taken a toll on their workers’ well being, said Olivia Webb, a healthcare writer. Cigna, for example, recently announced that it was partnering with Ginger to provide virtual behavioral healthcare services available to its 14 million members.
As different insurers’ initiatives unfold, Webb said the market will divide based on the demographic of patients served. She believes that white collar workers generally prefer virtual video behavioral healthcare services—which several studies have indicated result in same, or near equivalent outcomes as in-person care—since it does not require people to travel and can feel more private, but for blue collar workers who lack easy access to the internet the CVS model may prove more effective. And, if the retailer accepts cash pay for therapy, she said it could further increase access.
“The small town community doctor model is unfortunately falling away and I think that the new model is less personal and, maybe, worse quality, although I don’t know if there’s enough data to support that right now,” Webb said. “But I do think that it’s democratizing access.”
Dr. Andrea DeSantis agreed that CVS’ initiative increases access for patients, particularly those located in rural areas. But the North Carolina-based family physician also noted that it could increase the administrative burden for patients and primary care providers and, ultimately, lead to more “cookie cutter” care for individuals.
“When retail starts getting into the act of filling a narrow need, who’s gonna hold them accountable if the patient has other health problems?” DeSantis said. “Whose going to hold them accountable if they can’t pay their bill? Whose going to hold them accountable if they can’t handle something that’s out of their league? Where’s the warm handoff?”