This issue includes a full look at the results of our MHE State of the Industry survey!

Take a Look at our January Issue!

Those living with HIV and who abuse drugs experience worse health outcomes than those who aren't using. However, a 

 conducted mid-2021 reported those with HIV who abused drugs and have not had dental care use, experience a greater need of care.

With or without dental care, folks who have HIV and use drugs experience worse health outcomes than their non-using counterparts because substance use can speed disease progression, affect adherence to antiretroviral therapy, and worsen the overall consequences of HIV.

The clinical trial, Project HOPE (Hospital as Opportunity for Prevention and Engagement for HIV Infected Drug Users) sought to improve engagement in HIV outcomes, according to researcher and co-author of the study, 

.  Santella is also professor of Health Administration and Policy, director of the Doctorate of Health Sciences program for the School of Health Sciences, and 

"As a researcher, I used this dental utilization data to assess factors associated with dental care utilization among Project HOPE participants, with a research question focused on understanding the relationship between sociodemographic, HIV care, and risk factors with routine dental care utilization among PLWH (people living with HIV) with substance use disorders," Santella said.

The analysis was part dome with data from a large, national clinical trial of just over 800 people living with HIV with substance use disorders who were inpatients at 11 urban hospitals. In the trial, dental care use was measured at each time point during the study period (baseline, 6 months and/or 12 months). 

It was found that over half (59.4%) reported not having received any dental care at any time point. 

Santella shared those with HIV-related symptoms and an AIDS diagnosis have a greater need for dental care than those with fewer symptoms and without AIDS, but eclipsing needs for physical and mental health services limit their access to dental care. 

He added access to oral health programs has shown to improve physical and mental health. In a sample of low-income people living with HIV, engagement in an oral health program was associated with improvement in overall wellbeing.

In relation to the study, many variables of social determinants of health (SDoH) were looked at to find solutions in HIV care.

For example, participants with less than high school education had lower odds of reporting dental care utilization than those with more than education. Data also revealed those without health insurance also had lower odds of reporting dental care utilization than those with insurance. Higher food insecurity was also associated with having recent dental care utilization as were those from Southern states.

In the study, food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) which consists of nine items measuring one’s experience with insecure food access - each item scored on a scale of 0 to 3 where 3 represents the highest frequency of occurrence. 

Data found participants who had higher food insecurity had greater odds of reporting recent dental care. Findings from a retrospective analysis of National Health and Nutrition Examination Survey data found an association between food insecurity and unmet dental needs, which may be directly due to oral health problems causing trouble with eating. While the results differ, the dental setting represents an often untapped, but potentially useful venue in the provision of patient education in the subject of food insecurity, he Santella added.

It's recommended that the association between food insecurity and dental care utilization among this population needs further exploration.

Overall, having more access to dental care can better the outcomes of HIV patients who have substance use.

"The mouth is the gateway to the body," Santella said. "Oral health impacts physical health and physical health impacts oral health. Having access to quality, affordable dental care may mean a person is more likely to be linked to and engaged in care which should lead to better health outcomes."

"Research has shown a synergic relationship between oral health and wellness, so the more we can promote oral health in people with HIV (including those who use drugs), the better off they will be in maintaining quality of life."

Articles

Those living with HIV and who abuse drugs experience worse health outcomes than those who aren't using. However, a study conducted mid-2021 reported those with HIV who abused drugs and have not had dental care experience a greater need of care.

Dental Care Improves Health Outcomes of HIV Patients with Substance Use Disorders 

Too often, patients with chronic illnesses can feel like a burden to their clinicians or caregivers.

Chronic illnesses do not take days off — they are called “chronic” for a reason. Since most patients (and clinicians, for that matter) are unable to spend all day, every day, in an exam room, a large portion of day-to-day disease management falls on the patient themselves. This weighty responsibility can take a 

significant toll on a person’s mental health

To put self-management challenges into perspective, this section will focus on a chronic illness that 

 and causes 1.5 million deaths a year: diabetes.

Outside of the clinician’s office, diabetes management is a patient’s round-the-clock responsibility. Patients must watch what they eat, monitor their blood sugar levels, take their medications, maintain a routine of moderate exercise, and some must self-administer insulin injections multiple times a day. They must also know what to do in the case of a health emergency, such as a sudden spike or dip in blood sugar levels, which can lead to dizziness, loss of consciousness, vomiting, and other symptoms ranging from disruptive to life-threatening. And the more complex their diabetes is, the more challenging patient adherence becomes.

If they manage their condition well, people with diabetes can lead relatively normal lives. However, everyone has their own unique set of circumstances influenced by their underlying physical health, personal history, geographic location, economic stability — the list goes on. That said, there are a few issues that stand out as 

consistent barriers to effective diabetes management

Lack of education and understanding of the condition

In order to truly understand how to self-manage, patients with complex diabetes and their families or caregivers require educational support about the effects of disease on the body and how medication, exercise, and lifestyle adjustments can counter those effects. And since most people rely on general practitioners for their primary healthcare, they may be missing crucial, disease-specific education.

A patient’s socioeconomic status, age, cultural beliefs, and additional health factors can inform how they perceive advice for self-management — or make it more difficult to access assistance. Underlying psychological factors including 

anxiety, depression, and eating disorders

 can also compound these issues or act as additional barriers to adherence.

When patients think of their treatment as difficult or complicated, they are less likely to adhere to their self-management as recommended. Clinicians need to ensure that patients are not experiencing adverse effects — both physical and mental — related to using medications or at-home treatments. It is also important for clinicians to understand if patients have any unpleasant feelings associated with medication, such as a fear of injections or difficulty swallowing pills.

In countries without universal healthcare, 

 that out-of-pocket costs are an important determinant of how likely patients are to adhere to their treatment. Patients who have lower incomes are more likely to face economic barriers to consistently taking their prescribed medications. Patients cannot be expected to overcome their own economic barriers, and many general practitioners are ill-equipped to help patients access more affordable treatment.

If unaddressed, these barriers to successful adherence can lead to a decline in the patient’s condition, lower quality of life, development of additional health issues, long-term or repeated hospital admission, or death.

Despite these multifaceted challenges, there are steps clinicians and patients can take to improve patients’ access to and experience of disease management.

How to improve patient care delivery systems

When patients understand and feel engaged with their own care plans, they are much more likely to adhere to clinical recommendations.

The patient’s relationship with their healthcare provider is one of the most important interactions in healthcare, but it is only one part of a larger system of support. Augmenting the patient’s care team with a variety of support specialists — such as health coaches, counselors, care coordinators, and disease educators — can help patients adhere to treatment regimens and experience better health outcomes.

These methods of patient support can vastly improve self-management between office visits and make appointments more efficient and productive.

Approach communication from a patient-centric perspective

Provide multiple communication touchpoints

How to help patients overcome barriers to adherence

Even if it feels counterintuitive to a clinician, the key to overcoming patient non-adherence is this: Healthcare professionals need to position the patient as the primary decision-maker in their own care and actively support the patient’s efforts to achieve their care goals.

Clinicians can embody this approach by asking the patient questions such as:

“What would you like to get from today’s visit?”

“How can I help you reach your goals?”

“What confuses, concerns, or frightens you?”

“Do you need help identifying less complicated treatment options?”

“Do you need help finding less expensive treatment options?”

Integrating activities such as goal setting and problem solving into routine appointments will help facilitate patient and clinician communication that goes beyond mere status updates. Additionally, connecting patients with health coaches gives them an opportunity to easily ask questions and share self-management updates between appointments.

Healthcare professionals need to make patients the primary decision-makers in their own care and actively support their efforts to achieve their care goals.

Overcoming Patient Barriers to Chronic Disease Management

The dust still hasn’t settled on the FDA’s controversial decision last year to approve Biogen’s Alzheimer’s drug, Aduhelm (aducanumab). Last week CMS announced that it is proposing to cover the drug only if the patient is enrolled in an approved clinical trial, a move that seems to reflect concern the FDA’s OK was based on shaky evidence. Biogen fired off a press release said if the Jan. 11 coverage decision doesn’t change, nearly all Medicare beneficiaries will be denied access to its drug. Biogen had already tried to blunt some of the criticism of its anti-amyloid drug by slashing its price in half, from $56,000 a year, on average, to $28,200.

5 Things You Should Know About the Aduhelm Price Cut

Most of the respondents to our annual State of the Industry are in the skeptical/critical camp when it comes to Aduhelm: 54% indicated that they believed it was a mistake for the FDA to approve the drug. The survey had 100 respondents, although not every respondent answered all the questions.

Aduhelm was approved on the FDA’s accelerated pathway, which, among other things, means a drug will be judged by the agency on its effects on surrogate markers for management or control of a disease rather than on manifestations of the disease itself. The solid majority believes the Aduhelm approval was a misstep but an even larger majority (74%) of the respondents indicated that they didn’t think the FDA has approved too many drugs through the accelerated approval process.

Most (54%) respondents indicated that they believe the FDA made a mistake when it approved the controversial Alzheimer’s drug in June 2021.

Managed Healthcare Executive® State of Industry Survey: Aduhelm OK Was a Mistake, Accelerated Approvals are not

COVID-19 will continue to cast its long shadow on U.S. healthcare in 2022. But for population health, there is that silver lining people so often look for:
innovations and adoption of telehealth that started in 2020 will continue in 2022, even if the peak use of telehealth has tapered off. Providers and payers are also continuing to move “upstream” to the social determinants of health (SDOH), investing in housing, transportation and other factors that affect people’s health but are outside of traditional healthcare. 

Another major agenda item for population health leaders next year is efforts to address healthcare disparities. Disparities in outcomes and access are deeply rooted problems that lend themselves to a population health approach — but not to quick fixes. 

Almost two years after COVID-19 forced a telehealth revolution, patients have come to expect live video interaction offerings from their health plans and providers. Telehealth — which once meant having a live video visit with a physician — has become a commodity, with hundreds of options now available to patients, says Sebastian Seiguer, J.D., MBA, CEO of 

, a medication adherence company in Baltimore that is a Johns Hopkins spin-off. Simultaneously, the very definition of “telehealth” is changing, as consumers and providers alike become comfortable using a variety of digital tools such as texting, online portals and artificial intelligence (AI)-powered chatbots to give personalized healthcare advice and support.

Specifically, Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth in Watertown, Massachusetts, expects virtual care to continue to evolve, as it expands from a reactive mode of handling sick visits to incorporate proactive, convenient, preventive care. This is particularly true for patients working with care teams to manage chronic illnesses. In tandem, wearables, which provide the ability to monitor health at home, will gain popularity.

Along these lines, Nina Birnbaum, M.D., medical director of innovation acceleration at Blue Shield of California, says that more home monitoring is coming online with on-demand electrocardiograms, continuous glucose monitors and other opportunities for people to actively engage in their healthcare. These tools should help physicians better determine what diagnostic workups and treatments are needed, potentially lowering costs.

One example of telehealth saving money occurred when the Fresno County, California, Department of Public Health used emocha Health’s digital medication adherence program for one year. The department avoided about 110,000 vehicle miles while saving $10,000 in fuel and $100,000 in salaries, Seiguer says.

Another group of products are from companies looking to amplify existing models of in-home care with technology. A company called Heal is looking to bring back house calls; Papa Health provides healthcare worker visits and general help at home for lonely older adults; and Ready offers in-home urgent care visits. These are just a few examples of emerging categories, with some players overlapping and others defining entirely new segments, Seiguer says.

Telehealth can also enable a hesitant or time-constrained person to access care conveniently and quickly, helping to catch disease progression earlier and ultimately prevent small problems from becoming big ones, says Karen Ignagni, president and CEO of EmblemHealth in New York, New York. In addition, telehealth helps to manage chronic conditions and treatment adherence by providing simple, quick ways for people to check in with providers.

The government is beginning to recognize the benefits of telehealth and, more broadly, care that is delivered remotely and digitally. CMS provided reimbursement guidance for a new category of digital health, remote therapeutic monitoring, in early November 2021 that compensates providers for caring for patients outside of a physician’s office. Healthcare providers have not had a financial incentive to ensure that their patients understand and take their medication completely and properly. These new remote therapeutic monitoring codes provide reimbursement for the kind of support that can lead to greater adherence, Seiguer says.

An emerging trend in tackling SDOH is a greater focus on analyzing barriers to care at the population level and then investing in community programs that can have the greatest impact on the most people. Sweeney-Platt says that providers and payers both have obstacles to overcome. 

“While provider organizations are driving these conversations — especially those who have taken on Medicare Advantage or managed Medicaid risk — they don’t always have the resources to build programs,” she observes. “Payers have also invested in these types of programs but have struggled with low adoption. This leaves a lot of opportunities for payer and provider collaboration.”

SDOH present issues that can’t be solved peripherally, say experts. “Successful organizations are those that can marry sophisticated network-level analytics in order to identify hot-spot practices with common sets of needs, with deep local knowledge of community resources and partnerships,” observes Sweeney-Platt. 

Among the biggest challenges, she adds, is determining who pays for these programs. Robert Bollinger, M.D., M.P.H., a professor of infectious diseases at the Johns Hopkins University School of Medicine and one of the inventors of the technology licensed to emocha Health, says healthcare institutions should engage in strategic public-private partnerships with government and nongovernmental programs (e.g., Medicaid, community/faith-based organizations) to address SDOH issues. He also says they need to push for more resources to support SDOH efforts.

There is a good deal of overlap between dealing with SDOH and closing healthcare disparity gaps. Bollinger says it’s important to remember that any population health effort to address SDOH must also take into account racial discrimination — in society as a whole as well as in healthcare. He listed some steps that leaders of healthcare entities can take to begin to deal with disparities:

Prioritize the measurement and report health disparities based on race and other SDOH factors within their clinics, facilities, digital programs and among providers.

Build meaningful partnerships with trusted community partners — churches, local politicians — to enable patients and members to play significant roles in developing solutions that are meant to address these disparities.

Make racial equity a strategic priority for an entire organization. Many organizations are emphasizing and implementing training, cultural competency or workforce diversity initiatives. But training alone is not sufficient. “Equity needs to be more than a standing topic for every C-suite meeting, leadership meeting and program,” Bollinger says.

Christopher Dodd, M.D., chief medical officer of PopHealthCare in Franklin, Tennessee, and its home care business, Emcara Health, says that Emcara deploys home-based advanced primary care teams that include culturally aligned community health workers. “This approach enables us to build trusting relationships with underserved community members,” Dodd says. This model, along understanding the social and environmental factors affecting health, helps to prevent serious and costly health issues before they arise, he adds.

Karen Appold is a medical writer in the Lehigh Valley region of Pennsylvania.

Telehealth, efforts to address social determinants of health and a focus on health disparities are likely to be among the top priorities in population health this year. 

3 Population Health Trends to Watch in 2022

“Stay home.” We all remember hearing these words when the COVID-19 pandemic first took shape in spring 2020. While most complied and were able to minimize their contact with others, many in institutional settings, such as nursing facilities, were still surrounded by people. This environmental challenge resulted in 1 in 10 people living in nursing homes dying from COVID-19 during the pandemic.

This information points to opportunities for growth in long-term services and supports (LTSS). 

 refers to “the broad range of paid and unpaid medical and personal care assistance that people may need…when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.” LTSS goes hand in hand with Medicaid, as Medicaid pays for more than half of the nation’s spending on these services, according to a recent report by Medicaid Forward.

A National Association of Medicaid Directors (NAMD) report

 explores how states could help improve the lives of the individuals who use LTSS services—mostly older, low-income adults, and children and adults with complex health needs or disabilities—using what they learned from the COVID-19 pandemic and the more than $9 billion invested by Congress through the American Rescue Plan Act.

The largest movement associated with this population involves a concentrated push to move a majority of LTSS services from institutional settings to Home and Community-based Services (HCBS). HCBS encompasses assisted living facilities and in-home care, which broadly represents the “services and supports that allow people to live more independently and in their community.”

This incentive is fueled by an array of objectives:

Provide a safe alternative to the institutional environment caused by the pandemic

Make LTSS more cost-effective by acting on decades of proof that HCBS is a cost-effective alternative to institutional care

Increase at-home access to care by using technologies such as telehealth, remote patient monitoring and medication management tools that foster independence, improved health and increased safety

Respond to an increased demand for HCBS, born out of the concept of person-centeredness: “putting the individual and their unique needs at the center of service planning and care delivery”

The importance of at-home and community care cannot be discounted. In addition to the financial benefits associated with managing LTSS needs within the community, HCBS services are shown to be safer and boost well-being. Self-direction, a key component of person-centered care, allows individuals receiving HCBS services to manage all aspects of their service plan. This adds to their ability to remain independent, thus increasing their satisfaction level and enhancing their relationships with the providers they choose.

While there are many reasons to transition traditional LTSS services to the HCBS environment, 

“Natural supports,” such as family, friends and schools that help care for these populations at home are suffering from increased levels of mental illness and stress, affecting their ability to provide proper support and care.

The LTSS workforce is severely understaffed: The pandemic and an increased demand for home and community-based care has decimated the HCBS worker population. The U.S. is expected to need approximately 3.4 million direct care workers by 2030 to serve the needs of the aging population.

A growing need for LTSS in the next 40 years—as the number of Americans aged 65+ doubles and the number of Americans 85 and older quadruples—will strain institutional care infrastructures, heightening the emphasis on home and community care support systems.

Although the future landscape may seem daunting, states can overcome these obstacles by maintaining a focus on person-centered care and implementing strategies to address these environmental and workforce challenges. For example, access to at-home care can be improved by increasing benefits and incentives for personal care workers and natural supports, both of whom can help provide higher quality care if their monetary and personal needs are met. Targeted improvements such as these will help attract and retain the personnel needed to satisfy growing requirements relative to demand for home and community care.

While there is still much work to do, several states have already initiated efforts to bolster this critical workforce.

Washington State provides advanced training and pay increases depending on how long a care worker has been in their position.

Rhode Island offers pay raises to those who have attained a certain training level or certification.

Colorado pays family members who care for loved ones if they become Certified Nursing Assistants.

While these are steps in the right direction, widespread transformation can only occur if other states follow suit. The onslaught of problems brought on by the pandemic coupled with the money invested by Congress through the American Rescue Plan act gives states a huge opportunity to improve the lives of those Medicaid members receiving long-term services and supports. Giving everyone the ability to “stay home” is a cause worth fighting for.

 is Senior Vice President of Government Affairs at Modivcare.

Long-Term Medicaid Support Services Move to the Home and Community

Scratch beneath the surface of almost any recent trend in healthcare and you’ll find that it is not as new as it might first appear.

But there is really nothing new about consolidation in healthcare. Hospitals have been combining into larger, market-dominating systems for decades. According to a 2020 Medpac report, 90% of hospital markets met Federal Trade Commission definitions for “highly concentrated” in 2017 and there are no indications of the trend reversing since then.

The same is true of the payer side of the street. The Medpac report says 21 of 51 regions (the states plus District of Columbia) had group insurance that were super-concentrated.

Even if consolidation isn’t news, it ranked among the top concerns of the 100 respondents to our annual State of the Industry survey. In fact, it was the top issue when we asked respondents to rank issues in order of importance.

Managed Healthcare Executive® State of the Industry Survey, A Look Ahead , First Installment

We asked also asked which consolidation trend is most likely to accelerate in 2022. Vertical integration of providers (40%) and horizontal integration of providers (24%) garnered many more responses than vertical integration of payers (13%) and horizontal integration of payers (12%).

The Biden administration has said it is going to increase antitrust scrutiny of consolidation in all aspects of the economy, including healthcare. A solid majority (59%) of the respondents to our survey said they favored the administration using antitrust law to slow down or block consolidation among providers.

Forty percent of the respondents to our annual State of the Industry survey expect vertical integration of providers to increase this year.

Managed Healthcare Executive® State of Industry Survey: More Consolidation of Providers in 2022

: When you discuss next-generation sequencing and comprehensive genomic profiling platforms, ordinarily the first thing that comes to mind is a patient with advanced stage disease. Since 2021, and within the next few months, we have a number of studies emerging suggesting that particularly liquid biopsy—circulating tumor DNA [ctDNA], RNA, or epigenomic abnormalities—can help us either diagnose patients earlier as per screening or to help us identify which patients after surgery are at risk for recurrence. We call that MRD, or minimal residual disease. The examples I use here is we have an FDA [Food and Drug Administration] approval for an 

[epidermal growth factor receptor] tyrosine kinase inhibitor, osimertinib [Tagrisso], after surgery in patients with stage II and III non-small cell lung cancer who have undergone surgical resection and their cancer is found to have one of these 

 mutations. In the future, I’m quite confident that assessing liquid biopsy after surgery will help identify which patients are at greatest risk for recurrence, and which patients might benefit the most. For example, if the patient has the surgical procedure, they had an 

mutation in their cancer and may be shown in blood before surgery, now it’s a month after surgery, you repeat that liquid biopsy and it’s a negative, that patient may be cured. Not sure, but they may well be. On the other hand, if you find that same 

mutation in their blood 4 to 6 weeks after surgery, they’re almost guaranteed to relapse. This may help us, for example, differentiate who needs these adjunct therapies and who does not. The same will apply to the recent FDA approval for immunotherapy with atezolizumab [Tecentriq]. For instance, if the ctDNA a few weeks after surgery is still positive, it’s quite likely that those patients are the ones who will benefit the most from therapy. We need to show this, those 2 trials I just mentioned, have blood collected and eventually we will know this information. If it is as I expect it will be, this will be a huge step forward in resource utilization. Which patients need the therapy, which patients do not.

Videos

Closing out his discussion on CGP, David Gandara, MD, looks toward future opportunities for CGP in screening patients before or after surgery.

Expanding the Use of CGP in Screening and Surgery

In this on-demand society in which people want what they want, when they want it, experts are predicting consumers will continue to turn to retail clinics for their healthcare needs in the coming year.

With millions of Americans having received their COVID-19 vaccinations at retail clinics, “people are getting more familiar” with such clinics and “realize this has a real place in the care continuum,” says Neal Batra, a principal in the life sciences and healthcare practice at Deloitte Consulting. “The industry is convinced you’ll be able to (receive) some portion of your primary care not from a classic doctor’s office,” he adds.

The clinics at drugstores such as CVS, Walgreens and Walmart are a draw because of their convenience and easy access, says Joyce Yu-Chia Lee, a health sciences clinical professor at the University of California, Irvine. The goal is to “seamlessly integrate into their (consumers’) busy lives,” says Willie Hoag, co-founder of Tether Advisors, a commercial real estate advisory firm.

But not everything is so rosy for retail healthcare clinic operators. They are fighting off lawsuits accusing them of responsibility for the opioid epidemic. In late November, a federal court jury in Cleveland found that CVS Health, Walmart and Walgreens had contributed to the cause of opioid overdoses and deaths in two Ohio counties. There are also the headwinds of healthcare delivery’s migration to telehealth and in-person shopping to online. CVS announced in November it was shuttering 900 drugstores around the country over the course of three years, or roughly 1 in 10 of its 10,000 locations. “Organizations are still looking for that magic formula for what works for retail primary care,” notes Batra.

And CVS is still trying to shift from being a retailer of healthcare products and drugs to a provider of healthcare with its HealthHUB locations that offer a variety of healthcare services, such as mental health therapy, screening for chronic conditions and health classes.

During an investor’s day presentation on Dec. 9, Karen Lynch, the company’s CEO, said CVS is “transitioning what we call stores to health destinations.” In the future, Lynch said, the company’s physical locations will fall into one of three categories: primary care clinics with a “high level of clinical services,” HealthHUBs “with products and services that support everyday health and wellness” and traditional pharmacy locations. Lynch did not say how many locations would be in each category. She also painted a picture of CVS moving more fully into primary care, shifting away from what episodic care to what she called “longitudinal care.” 

CVS, which acquired Aetna for $69 billion in 2018, is marketing health plans that encourage consumers to use CVS by offering care at its MinuteClinics with no copays.

Meanwhile, Walmart seems to be experiencing healthcare hesitancy. The giant retailer opened just 20 of the 125 clinics it had planned to open by the end of 2021, Insider reported. Walmart executives didn’t even mention retail clinics in their November earnings call. In the August call, Doug McMillon, the company’s president and CEO, said, “The work we did to build some clinics has been helpful, and I think we’ll have more clinics in the future. But the clinics aren’t the thing on its own.” He also referred to the role of telehealth, and healthcare at home and on mobile devices and the importance of directing consumers “to the place to get the right care at the right time.”

On the other hand, Walgreens seems to be forging ahead with its partnership with VillageMD. The retailer announced in October it was investing $5.2 billion in VillageMD to increase the delivery of value-based primary care. With that investment, Walgreens upped its stake in VillageMD from 30% to 63%, and VillageMD plans to hold an initial public offering next year.

With the Walgreens investment, VillageMD plans to open at least 600 Village Medical clinics at Walgreens in more than 30 markets by 2025 and 1,000 clinics by 2027. More than half are slated to be developed in medically underserved communities. Because it is expensive to build clinics, retailers have an advantage by already having brick-and-mortar locations in place, says Hoag.

So far, only a relatively small group of people use retail health clinics. A Morning Consult poll of 2,200 adults conducted last year found that just 8% of respondents indicated they went to a retail clinic for medical services often and 27% said they used the clinics “sometimes.” But more than 70% of the respondents said they trusted retail health clinics and 10% said they would go to the clinics “often” after the pandemic, whereas 45% said they would go there “sometimes.” Additionally, the majority of respondents said they valued the quality of care, cost of service and convenience of such clinics.

But respondents were split when asked whether the quality of services was the same quality as they would receive at a traditional doctor’s office. About one-third said it was the same, more than one-quarter said it was worse and about 30% said they didn’t know.

The pandemic has driven growth in retail clinic usage, observes Gurpreet Singh, U.S. health services leader for PwC, a consulting firm. A pre-pandemic 2019 survey by PwC’s Health Research Institute found that 30% of U.S. adults had visited a retail clinic. A September 2020 survey found that the share of respondents who visited a retail clinic had climbed to 40%, and about three-quarters said they would use a retail clinic again.

The clinics tend to provide care “especially for people who do not have a primary care physician,” such as younger people, notes Lee, the University of California, Irvine, professor. “Retail is more geared to people with less complicated conditions,” she adds.

One aspect of retail healthcare that has perhaps not received as much attention as others is the pricing. Batra notes that prices are transparent, so people know what they are going to be charged, in stark contrast to the often-opaque pricing in traditional healthcare. But he also points out some drawbacks of retail healthcare. The services are often limited. If someone needs, say, three services, they may find that only two are provided by the retail clinic. For that and other reasons, retail health is not going to replace primary care physicians, says Batra.

Hoag believes that the future of the retail clinics lies in providing preventive care — which is consistent with the vision that Lynch mapped out. With their numerous locations, retail clinics can play an important role in increasing health equity, says Singh: “Being part of the community can and should result in more activism in the community and better representation of the demographics.”

Susan Ladika is an independent journalist in Tampa, Florida.

Walmart seems to be pulling back and opioid litigation looms.

Bumps in the Road Ahead for Retail Health 

Dr. Scott Edmonds is chief eye care officer at UnitedHealthcare.

With persistent spread of the virus that causes COVID-19 nationwide, some traditionally in-person activities – work, school and social interactions – will likely remain remote more often than usual for the foreseeable future.

As a result, the use of digital devices has surged significantly as people spend more time at home, with Americans logging an average of 

. That compares to between seven and 10 hours per day before the COVID-19 pandemic started, with the increase in screen time likely contributing to more exposure to blue light.

While this low-wavelength, high-energy light offers 

, such as boosting alertness and elevating moods, too much of it may cause problems. Researchers continue to evaluate the potential short- and long-term 

 that may come from excessive exposure to blue light, including potential damage to retina cells, particularly in children and teens; increased incidences of age-related 

Here are five eye health tips to consider as the consistent use of digital devices remains a fact of life for people of virtually all ages:

1.) Look for warning signs of digital eye strain.


 of digital eye strain, which may result from extended computer and smartphone usage and can contribute to dry eyes, headaches and neck or shoulder pain. For parents, it is important to look out for digital eye strain and other signs of vision problems, as children may not be aware and won’t complain if their eyesight isn’t normal. Red flags may include squinting while reading or watching television, or difficulty hitting or catching a ball while playing sports. These issues can indicate an underlying vision problem that might require glasses or other treatments from an eye care professional.

 a screen while looking slightly downward — a few inches below eye level — while maintaining the device at least 30 inches from their eyes, as this separation can help reduce blue light exposure. Keeping this distance is especially important for children, as young people often hold digital devices closer to their faces than adults do, thus potentially leading to a higher amount of blue light. For people with computer-based jobs, it may be helpful to place reference documents so their head does not need to be repositioned to see them, such as above the keyboard, below the monitor or on a document holder.

3.)Use the 20-20-20 rule or other rest tactics.

 
It is important for people to give their eyes some rest during the day by breaking up long stretches of screen time. The 

 recommends that after 20 minutes of computer work, people take 20 seconds to look at something that’s approximately 20 feet away. Another strategy is to switch to a task for which their eyes don't have to focus on something up close, such as returning a call, connecting with a co-worker or taking a walk. Also, getting outside and away from digital screens may reduce the risk of developing nearsightedness, which has become increasingly common in part due to the increased use of screens, and today 

4.) Leverage blue-light-blocking technology.


Many smartphones now include a “night mode” feature, which adjusts the screen’s setting to help filter out blue light. Likewise, 

 can feature blue-light-filtering properties, while also helping prevent cracks or scratches. To help block blue light at the source, some computer manufacturers are 

embedding blue-light-filtering technology into the screens

, helping ensure color clarity while reducing exposure to blue light. Another option is to get glasses with premium anti-reflective coating, which may help prevent harmful reflective glare and 

It’s a good idea for computer users to get 

 every year, according to the American Optometric Association. If people experience ongoing symptoms of digital eye strain, prescription lenses for computer viewing may be needed. Plus, a comprehensive eye exam may uncover other health conditions not usually associated with the eyes, including diabetes and even some types of cancer. For children, it’s important to remember that a school’s vision check is not a substitute for a comprehensive eye exam, as screenings usually focus on measuring acuity levels and might miss common conditions such as poor eye alignment, focusing problems and farsightedness.

As we contend with the ongoing pandemic and transition to an increasingly virtual world, considering these tips can help people maintain or improve their eye health as part of an overall focus on whole-person well-being.

The use of digital devices has surged significantly as people spend more time at home, with Americans logging an average of 13 hours per day watching screens. That compares to between seven and 10 hours per day before the COVID-19 pandemic started, with the increase in screen time likely contributing to more exposure to blue light.

Five Tips to Help Block Blue Light in an Increasingly Remote World

While the United States continues to wrestle with the consequences of the COVID-19 pandemic, one thing remains clear: the hospital staffing shortage is persistent.

Press Ganey reports that 30% of RNs are at risk of leaving their organization.

 At the same time, 71.6 million baby boomers face health problems associated with aging. Analysts fear there will be too many patients for the system—and not enough available nurses to manage their care.

The “Hospital at Home” (HAH) care delivery model may be one of the actions hospitals and health systems can take to alleviate some of the stress these shortages are putting on our already strained healthcare system. By making acute hospital-level care available to adults in their homes through dedicated paramedics and physicians, hospitals can free up some nurses to care for the most critically ill on-site, improve patient outcomes and increase patient satisfaction.

A safe and effective alternative to inpatient care

Some participating hospitals have demonstrated cost savings of 38% 

or more by implementing HAH programs. They also claim that HAH has helped them alleviate staffing strains by releasing inpatient beds so that hospitals are not boarding patients in the emergency department - a critical issue during this pandemic.

HAH can also result in better care outcomes. It prevents patient exposure to foreign bacteria in a hospital and enables caregivers to see, track, and share the complete picture of a patient's condition and lifestyle.

Research has shown that, compared with patients receiving inpatient care, patients receiving HAH care had a shorter length of stay (3.2 days compared to 5.5 days in one study example), lower rates of 30-day hospital readmissions, emergency department visits, and skilled nursing facility admissions; and better ratings of care. 

Recognizing its potential to help increase available bed capacity during the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) expanded its Hospital Without Walls initiative to launch the “Acute Hospital Care at Home” program.

Since the program’s introduction, more than one hundred hospitals have received approval from Medicare to participate in hospital-at-home care. 

Developers of the highly regarded Johns Hopkins Hospital at Home® care model say that hospitals and health systems taking a HAH program into consideration as a good fit for their organization should be able to answer yes to one or more of these questions:

Is your health system experiencing problems from a lack of hospital capacity?

Does your organization have home healthcare delivery capabilities?

Do you have providers with an interest in caring for patients in the home setting?

Does your health system have a significant volume of Medicare admissions with diagnoses of heart failure, community-acquired pneumonia, or chronic obstructive pulmonary disease?

Does your institution value innovation when exploring new models of care? 

A dedicated hospital-at-home team focused on best practices

Those who have successfully implemented HAH will tell you that, in addition to complying with 

, it is vital to be aware of associated risks and mitigation best practices.

First, organizations must have a commitment from leadership and a team dedicated to HAH delivery. This includes physicians, nurses, paramedics, and staff trained in remote and at-home care nuances. This team must be solely dedicated to, and responsible for, the implementation of at-home patient care.

The dedicated team must thoroughly assess the patient’s appropriateness for the program. The ideal candidates cannot require intensive care and must be willing to participate in the program. Some patients express that they feel safer in a hospital setting and therefore would not be the best candidates for the program.

Critical consideration must also be given to the home setting's safety, security, and accessibility. Qualified staff must visit the home to make an honest assessment of any hazard that might put the patient at risk. This includes ensuring a stable internet connection for telehealth and remote monitoring to work consistently and confirming the patient is located no more than 30 minutes away from the hospital in case emergency care is needed.

It is also essential to conduct a thorough social assessment – interviewing those living at home, making sure there is a support system, and securing a commitment that a dedicated caretaker is available for the patient.

Organizations that engage in careful planning, establish a dedicated HAH team, define their patient selection process and perform thorough home environment assessments can implement successful and satisfying acute care at home experiences for patients and their families.

Proponents are hoping this trend continues beyond today’s critical need during the pandemic. They are placing their bets that the CMS waiver and increased awareness of HAH programs' success will help spur continued adoption and ultimately lead to a permanent CMS ruling.

is a risk management and analytics manager at 

, a medical liability insurance and risk management company headquartered in Boston.


 Press Ganey. (2021 September 30). New Findings from Press Ganey Reveal Millennial Nurses Are Most Likely to Quit, and Nearly 30% Of Nurses are at Risk of Leaving Their Organization [Press release]. 

https://www.pressganey.com/about-us/news/new-findings-press-ganey-reveal-millennial-nurses-are-most-likely-quit-and-nearly-30

 Bridger, H. (2020, January 23). Home Hospital model reduces costs by 38%, improves care, study says. Harvard Gazette. 