Consumer Driven Primary Care

Retail healthcare outlets, good or bad for long term health quality?

Retail healthcare options are steadily increasing throughout the country and in our Pacific Northwest in particular. Most of this is seen in the major metropolitan and suburban areas of Seattle and Portland. There are multiple companies located in our more rural areas that already have active retail healthcare businesses in the larger communities, including: Walgreens, Rite Aid, Target, Wal-Mart, and Fred Meyer. Other companies are offering telemedicine services which are available to patients across the state.

Current retail healthcare models arose due to multiple factors, but the largest appears to be consumerism. Savvy healthcare consumers are increasing demand for value as defined by access, price, and convenience when selecting their healthcare provider. This has resulted in part from the high deductible health insurance plans and changing consumer technologies such as mobile phone apps and telecommunication services. Patients are no longer satisfied with the traditional primary care model that often has restricted access and inconvenient times with little transparency in cost.

Retail healthcare options include straight fee for service models and membership models located inside retail pharmacy chains, grocery store chains and the large discount stores like Wal-Mart. The fee for service models offer a menu of different options with fixed pricing. Many include prices for ancillary services like labs and radiology as well. Membership models charge monthly fees for unlimited access to covered services with some additional costs for elective services. Telemedicine services allow you to call in from anywhere, at any time and receive service without physically being seen.

We already deal with lack of connection between Health Systems due to EMRs that don’t talk to each other. As more of these services pop up we will see more splintering of the patient record and thus my concern is that overall health quality will be affected in a negative way. In Primary Care the long term relationship is vital. The continuity required to diagnose and control illness and chronic disease will be diluted. I have concerns about over prescribing in these little outlets to please patients and meet customer expectations and not stick to evidence based guidelines.

My question is how do we avoid this fracturing of the primary care relationship and meet the ever increasing consumer demands, yet not compromise standards of care and quality?


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Participant comments on Consumer Driven Primary Care

  1. Consumerism is not necessarily a bad thing.
    Affordable and Accessible are two key factors in consumerism.
    Pizza now comes to your home and can now even track it to the minute to your door step. Rest of the industries have moved on, why can’t the medical industry adapt to that.
    What is important: the payer model, standards and outcomes of the service,be it short term or long term.
    Should that be subsidised by the various governments and to what extent and what cost.
    The standards of care, clinical governance and compliance should be instituted.
    Have regular accredited clinical meetings, regular audits of patient records against say 15 college standards by a lead doctor in the practice.
    In my experience people in a fee for service model,use different primary physicians for different problems. They will get a physician who is quick for colds and flus and repeat scripts and for complex issues they tend to see their “own GP”.
    Linking these practices with local area health bodies and not alienating them to begin with, is important in preventing fracturing care.

  2. This system is referred to as “consumer-driven healthcare” because claims are paid using a consumer-controlled account versus a fixed health insurance benefit. That gives patients greater control over their own health budgets and they are primary decision makers regarding the healthcare they receive. Consumer – driven healthcare shift the cost of healthcare to the back of patients especially people with chronic illness who spend heavily on daily medications. In our organization we have partnered with physicians, hospitals, nutritionists and pharmaceutical industries, this multidisciplinary approach of care has reduced the cost of hospitalization since the patient is engaged in his or her care.

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