A reboot for preventive health care

Dollar for health care dollar, nothing beats prevention. Here’s how the country can reclaim a missed opportunity.

Prevention is the first rule of good health. Yet only 8% of Americans* undergo routine health screenings. Vaccination rates* have been dropping for years. And while most U.S.residents can access preventive services* through their health care coverage, most don’t.*

“Preventive care is about the small things we can do to prevent future problems,” says David Fairchild, MD, Chief Medical Officer for Retail Health and Senior Vice President, CVS Health®. Yet missed prevention opportunities cost the United States $55 billion annually,* or an estimated 30 cents on every health care dollar, according to research from the National Academy of Medicine.

Some reasons for this fact are easy to identify.

The COVID-19 pandemic kept patients away from medical offices. For breast and colorectal cancers alone, pandemic-related delays* in screening could result in almost 10,000 deaths over the next decade.

Pandemic-related burnout* of providers also caused staffing shortages and record wait times for patients. People who see a primary care physician (PCP) are more than twice as likely to get vaccines and colonoscopies,* for example. But with growing provider shortages, about 3 in 10 people* now don’t have a PCP.

Other obstacles are long-standing. Overall, preventive care is too costly, inconvenient and difficult to access for most consumers. But a reboot of preventive care can tackle these problems, broadening access as well as lowering costs.

New approaches can make preventive care more available to everyone. And it can embrace and expand what works in primary care, allowing physicians to work together with nurses, pharmacists, social workers and other providers — both in-person and virtually.

Retail health clinics as preventive care centers

First, it will be important to rethink where care happens. For the past decade, retail sites of care, including retail health clinics and pharmacies, have been steadily expanding their abilities* to deliver preventive care.

Over the last five years, the use of retail clinics has grown 200%.* And in a survey by the Deloitte Center for Health Solutions last year, 55%* of all consumers said they were open to using a retail clinic for preventive care.

“MinuteClinic started out in 2000 as a provider of minor acute care, and its journey has been one of expanding scope,” says Fairchild. “Now we’re enabling primary care level of services, especially in the preventive care domain.” That now includes more than 125 preventive care services, delivered by nurse practitioners and physician assistants/associates. With their extended weekend and evening hours and 24/7 virtual care options, retail clinics can offer an element of convenience over traditional doctor’s offices.

During the pandemic, the public use of retail clinics and pharmacies skyrocketed* as destinations for testing, vaccines and routine care. MinuteClinic saw more than 5.5 million patient visits in 2022, making CVS Health one of the largest providers of episodic care in the United States. Accessibility, extended hours and the growth of virtual care may be a big part of that shift.

The 2022 Health Care Insights study from CVS Health showed that most Americans say convenience is the most important factor when choosing their primary care provider. For those who don’t have a primary care provider — which is one in four adults* and nearly half of those under age 30 — retail sites of care offer an attractive alternative.

“It’s increasingly apparent that there’s a huge role in preventive services for other providers, such as nurse practitioners and physician assistants. They complement what happens with a primary care physician in a way that makes it convenient for patients,” says Fairchild. MinuteClinic practitioners can help patients understand what services they might need, even if they come in for another problem. “They may initially come in for strep throat, but we can then let them know that they can get other preventive services such as a flu shot when they’re feeling better,” he says.

Retail health clinics can also offer critical preventive interventions in chronic disease management. A 52-year-old patient recently discharged from the hospital came into a CVS Pharmacy® with a new blood pressure prescription. The problem: He couldn’t book an appointment with a primary care provider for three months and only had a 30-day prescription. After a physical exam, MinuteClinic practitioners not only extended his initial prescription but also supplemented it with a second.

Pharmacists become prevention players

Pharmacies are another retail health care provider that took on a broader role for consumers during the pandemic, says Sandra Leal, Vice President, Pharmacy Practice Innovation and Advocacy, CVS Health. “The public health emergency showed that pharmacists can do more than simply dispense medications. They can be access points for testing, vaccines and even treatment,” Leal says.

Before the pandemic, many states were already giving pharmacists more expansive roles. Some states allow pharmacists to prescribe oral contraceptives (a service offered through CVS Pharmacy at 1,800 locations). Almost two dozen states allow pharmacists to prescribe drugs that can prevent HIV infection,* and some allow them to prescribe smoking cessation medications.* And two states allow pharmacists to prescribe cholesterol medications* to certain high-risk patients.

A national turning point was the government’s Test to Treat initiative launched in 2022. It allows pharmacists to evaluate COVID-19 positive patients and, if they are eligible, prescribe the oral anti-viral Paxlovid. This first-of-its kind effort allows all pharmacists to assess patients and prescribe treatment, giving patients quick access* to the medication, which needs to be taken within days of symptoms beginning to be effective.

“COVID-19 treatment is just one example of an expanded service that pharmacists can do,” Leal says. “Given added flexibility and authority, pharmacists can even assist patients with screening, monitoring, education and referral, if needed, for diabetes, behavioral health issues or cardiovascular conditions.”

Pharmacies are widely accessible, within five miles* of 90% of Americans. Research from CVS Health shows that 61% of U.S. adults* say they would like to be able to get a greater range of health services from their local pharmacy.* And 60%* report visiting a pharmacy at least once a month, a frequency that provides the pharmacist with more touchpoints to connect with and educate patients, Leal says.

Further steps for preventive care

A recent Gallup poll showed that one in three* Americans had put off medical treatment last year due to cost, and visits to physicians remain below pre-pandemic levels.*

Retail health clinics and pharmacies are two frontiers for reversing these trends.* And even though they complement the role that primary care can play, a wider and more integrated strategy will be needed — including the expansion of traditional primary care. Some of the strategies adopted by CVS Health include:

• An investment in primary care: Primary care providers have historically been the vanguard of preventive care delivery. Given the right tools and incentives, they can have an even greater impact. One model has been pioneered by Oak Street Health, a value-based care platform with 600 PCPs across 21 states. Oak Street Health, recently acquired by CVS Health, primarily serves Medicare and dual-eligible (Medicare and Medicaid) patients, about 45% of whom have risk factors around food, housing or isolation.
  
  PCPs at Oak Street Health have historically spent three times more time with patients than other providers. The time is spent listening to patient needs and challenges, even those that extend beyond traditional medical care. The care team — a PCP, registered nurse, medical scribe and medical assistant, who are in turn supported by behavioral health specialists, community health workers,
  medical social workers and others — help patients manage chronic conditions and social factors that might affect their care. The approach has led to a 50% reduction in hospital admissions. More critically, the model represents a shift from traditional, reactive care to proactive, highly engaged primary care.
  
  Separately, Aetna has built out new team-based models of primary care, in which physicians are joined by nutritionists, health coaches, pharmacists and social workers. This ensures disease management doesn’t stop when the office visit is over. At all touchpoints within CVS Health, patients are encouraged to take the “next best action,” a way to help them understand and manage their own care.
  
  
• An omnichannel imperative: The country turned a corner on virtual care during the pandemic, says Fairchild. But not everyone is a fan of the digital visit, and it might not serve every health care need — which is why providers need to be flexible. “Sometimes that interaction is going to be brick-and-mortar visits and sometimes virtual,” he says.
  
  More preventive care will also take place at home, according to a recent Deloitte report.* Signify Health, now part of CVS Health, is a pioneer in bringing clinicians into the home to identify chronic conditions, close gaps in care and address social determinants of health. Signify providers* help support the health care journey, including for those with complex conditions, such as chronic kidney disease and some cancers.*
  
  Signify practitioners meet with millions of people* in their homes every year.* While there, they collect hundreds of data points on a patient’s health and social needs to make sure that patients get connected to the right care for their needs.
  
  
• More attention to adherence: Disease management often hinges on taking the right drugs at the right time. Across the health care delivery channels at CVS Health, there is a focus on helping patients start and stay on their medications. This includes one- on-one conversations at a MinuteClinic check-up, the pharmacy counter or by phone, mail delivery service for Caremark® members and messaging through texts, apps and digital portals to get optimal uptake.

Above all, the preventive care landscape is spread over many moving parts that all need to work together. One major advancement made during the pandemic was giving pharmacy teams access to patient electronic health records, says Leal. This vital tool gives pharmacists visibility into a patient’s full medical history, which can help them alert patients to possible gaps in care.

Primary care providers, pharmacists, retail health clinics and other players are all focused on the same goal — a healthier population. Preventive services are key to getting there. “It’s really clear,” says Fairchild. “Helping people achieve health and wellness, and get the preventive services they should, has to be a team sport."