Why Doctors Are Coming Where You Live — and Shop

3 trends behind the growth of house calls and medical care in stores
The Mall of America on the outskirts of the Twin Cities in Minneapolis has more than 520 stores and restaurants, plus an indoor theme park. Last November, it added something else, the Health Fairview Walk-In Clinic with five medical exam rooms, lab space for tests, a radiology room and pharmacy services. Anyone can stop in.
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The mall’s health clinic is part of an intriguing shift in how health care is getting delivered in the U.S. Other accelerating signs of change: more doctors and nurses making house calls; Walmart’s first health clinic attached to a Supercenter store; CVS Health’s strategy to offer a broad range of health services in its stores by expanding its HealthHUB and MinuteClinic format and Walgreen Boots Alliance transforming stores into neighborhood centers for older customers.

Basically, taking health care to where people live.
There are three trends behind the growth of doctors coming to where you live and shop that reinforce one another.

Trend No. 1: The patient is increasingly a customer. Convenience and accessibility are critical for better, cost-efficient health and wellness care.  So, doctors, nurses and other health professionals increasingly will come to the patients’ homes, neighborhood and community.

Clinics in retail spaces and house calls are two sides of the same trend. “They’re taking health care to where people live,” says Lauran Hardin, senior adviser partnerships and technical assistance at the National Center for Complex Health and Social Needs.

Trend No. 2: The health care industry is shifting its focus from crisis care built around emergency rooms and hospitals toward a system emphasizing wellness and preventative care. Take the CVS HealthHUBs. The first three were opened in CVS stores in February 2019; the goal is to have 600 in 2020 and 1,500 by the end of 2021. Each HealthHUB has a MinuteClinic, the CVS-owned primary-care service in its stores that mostly deals with minor acute illnesses. But the HealthHUBS offer additional services, ranging from breastfeeding information to stress relief. A concierge helps people navigate their health and caregiving questions.

According to Forbes, CVS Chief Executive Larry Merlo told a JPMorgan Chase Healthcare conference this month that CVS Health HUBS are focused on offering 80% of what a primary care physician can treat.
“The real goal of the HealthHUBs is to bring different resources across the CVS enterprise in a setting that is easy, local, and convenient,” says Sharon Vitti, senior vice president and executive director, CVS Health/MinuteClinic. “More importantly, it’s to help people stay healthy and drive down the cost of health care… keep them healthy so they don’t need high-cost services.”

Trend No. 3: This one is, in many respects, the most important — the demographics of an aging population. Although the typical MinuteClinic customer is a younger adult, in recent years older customers have been showing up. So, CVS MinuteClinics partnered with Case Western Reserve University’s nursing school and the Institute for Healthcare Improvement to create training tools and resources making the clinics age-friendly.

The program emphasizes the Institute’s “4Ms” for older patients: What Matters to the patient; Mobility; Medication reduction and Mental and cognitive health.

The rise in house calls by primary care physicians, nurse practitioners and other health care professionals treating older patients partly reflects the realization that it’s much better for those with multiple symptoms to be seen at home.

Medicare has made reimbursement easier, too. Since January, 2019, health care providers have no longer needed to prove the medical necessity for a house call, rather than an office visit, for a Medicare patient.
But various demonstration projects have also shown that house calls are cost-effective compared to the traditional fee-for-service Medicare reimbursement policies that typically push people toward doctor and hospital visits.

Medicare-covered home visits use a value-based payment model — a flat fee per patient for primary care. The Independence at Home Medicare Demonstration Project saw $82 million in cost savings in its first four years, while improving quality of care. The American Academy of Home Care Medicine’s research found that per-patient savings range from $1,000 to $4,000 annually, due to fewer hospital and nursing home stays, emergency room visits and trips to specialists.

The value-based repayment model works well with private insurers’ Medicare Advantage plans, too, which stress improving the quality of everyday life for people 65 and older.

“I have been involved in home care for twenty-five years. We are at a tipping point with the aging of the society. The care makes such a difference to people lives,” says Dr. Thomas Cornwell, CEO of the Home Centered Care Institute and founder of Northwestern Medicine HomeCare Physicians.

Slowly but surely, health care is coming to where you live and shop. That’s convenient for you and your parents and the evidence suggests it might reduce the high cost of health care in America, too.

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