Disrupters are trying to upset the apple cart

February 18, 2019

You’re already acutely aware of how incredibly complex the health care landscape has become – and more change is on the way to continue shaking things up. Health care disrupters – including nontraditional partnerships, new direct-to-consumer companies and even public outcry – aim to change the traditional health care status quo. Basically, this is the health care version of what Lyft and Uber did to taxis. The genesis of this change isn’t totally off-base. Traditional health care can be slow to deliver new innovations and treatments, and until the last few years, has remained relatively stagnant, at least in terms of delivery methods. Health retailers are one type of health care disrupter that will drive practicing physicians – allergists included – to consider changing their delivery models and reducing costs of care.

Health retailers are already-existing stores, such as Walgreens, Walmart and CVS, that are trying to get a better foothold in health care by using their consumer data (on behaviors and purchasing patterns), along with new partnerships, to provide health care directly. Where I practice at Gundersen Health System, they recently published a brief outlining who these retailers are and what the future may look like. In it, they succinctly summarize what exactly is giving these retailers an edge as they enter the health care arena. “Unlike traditional health providers,” they wrote, “these health retailers have an opportunity to use their consumer savvy to bring patients into the fold and keep them coming back, using reward programs and other strategies. These health retailers also have well-established national and global brands and vast networks of store locations in urban and rural communities. This enables them to attract consumers looking for affordable, convenient care and health-related goods and services in an existing health ecosystem known for lacking both.”

Research now shows that 44% of patient visits are taking place when traditional doctor’s offices are closed, busy consumers juggling work, child care and other responsibilities are looking for more convenience and flexibility than the traditional health system has been able to provide so far. The demand for access to health care on patients’ schedules is part of what’s driving the growth of telehealth (another disrupter) as well. And all of this is moving patients away from their traditional family doctor – a survey by the Kaiser Family Foundation found that 45% of 18- to 29-year-olds and 28% of 30- to 40-year-olds don’t have a primary care provider. The profound generational difference here is obvious. While many news articles dismiss anything related to millennials as self-centered flights of fancy, it’s important to not ignore their preference for things like convenience, fast service, connectivity and price transparency. They are the nation’s largest generation – a whopping 83 million people – and will make up the bulk of patients in the near future.

While health retailers stealing a piece of the pie from primary health care providers isn’t new by any means, these stores have recently begun to vertically integrate – a shift that allows them to stand on solid ground in the health care landscape. The health care industry has started to take notice, and it’s important that allergists do too.

Two of the main health care retailers have made some major mergers just within the last year. The CVS and Aetna merger means that CVS now owns the largest pharmacy chain in the United States, a pharmacy benefits manager (Caremark) and now, an insurance company. It gives CVS more control than ever before over how people access and pay for their health care. Their goal is to create “health hubs” where patients will be guided through all aspects of the system. Aetna CEO Mark Bertolini was quoted in a Drug Store News article as saying “…we can waive prior authorizations, (and) we can wave copays as people use the system in a way that’s more effective so we can reduce costs.”

Walgreens, on the other hand, has partnered with both Humana and Microsoft. The partnership is designed to try to keep patients out of the more-expensive hospital setting and allow pharmacists to more closely monitor patients. Their partnership with Microsoft will focus on “digital health corners” where health-related devices and hardware can be sold, and they are looking to find a way to connect consumers, providers, pharmaceutical manufacturers and payers through a single platform.

What effect will these disrupters have on allergy? Does this spell the end for our specialty? While the exact effect remains to be seen, the end is certainly not nigh. Instead, allergists need to stay informed about the changing health care landscape around us and explore what we can learn from these disrupters. We will have to be able to make changes in our practices and evaluate how we can improve convenience for our patients and reduce the cost of care. This might mean offering increased hours, using telehealth and partnering with other health care groups in order to prosper in the newly-changed health care sphere. As we learn to be flexible and better cater to our patients, we are backed by the strong support of the College. The College has always stood with the community allergist and will continue to work hard to support our specialty no matter what changes occur to health care in the future. And that should give you greater peace of mind – I know it does for me.

Todd Mahr, MD, FACAAI
College president