CVS to Expand Telemedicine Services at In-Store Clinics

Mark Crane

August 28, 2015

CVS Health, the nation's second largest drugstore chain, will dramatically expand its telemedicine program by working with three major telehealth companies — American Well, Doctor On Demand, and Teladoc.

CVS Health, with 7800 retail drugstores and 1000 walk-in medical clinics, announced that it will explore how direct-to-consumer telehealth providers, retail pharmacy, and retail clinic providers can collaborate to improve patient care. Starting next year, the company will enable its in-store MinuteClinic providers to "consult with telehealth physicians to expand the scope of care offered," it said in a release.

"With the increased demand for patient care anticipated in future years as a result of the expansion of coverage through the Affordable Care Act, the primary care physician shortage, aging of the population and epidemic of chronic disease, telehealth gives us the opportunity to offer high quality care to an expanded group of patients in a variety of convenient and cost-effective locations," Andrew Sussman, MD, CVS Health executive vice president and associate chief medical officer, said in the statement.

"During our initial phase of exploration of telehealth in our store-based clinics, we learned that we could deliver excellent quality care and that patients were extremely satisfied with the care provided," he said. MinuteClinic data recently published in the Journal of General Internal Medicine showed that, overall, 95% of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care, the company said.

Part of "Dramatic Transformation"

The CVS Health initiative is "just one more action in the dramatic transformation we're seeing in parts of the healthcare delivery system," Jonathan Linkous, chief executive officer of the American Telemedicine Association, told Medscape Medical News. "The growth in telemedicine has been remarkable and is usually covered as a beneficiary service by insurers and employers."

An August 2014 Deloitte study predicted 75 million virtual visits in North America in 2014 and as many as 300 million visits a year in the next few years. Telemedicine services will be offered in health plans sponsored by 74% of large employers during the next year, according to a survey released by the National Business Group on Health.

"The driving reason is convenience for patients," Linkous said. "We see this expanding rapidly to other drug store chains as well."

Telemedicine does compete with primary care doctors but also augments what they do, he said. "The concern we have is closing the loop on coordination of care. Telemedicine is of great convenience to patients but ideally it should be more than just episodic. We need to get a link back to the primary care doctor so that the televisit becomes part of the patient's ongoing medical record."

Not a Popular Idea to Some

Linkous concedes that there's still strong resistance in some quarters of medicine. "State medical boards had initially been resistant but that's changing and more services are being allowed."

Texas is one major pocket of resistance. The Texas Medical Board, with the support of the Texas Medical Association, voted in June to require physicians to have an in-person visit with a patient before they can provide services through telemedicine.

Under the new rule, the provider-patient relationship cannot be established through "email, electronic text, or chat or telephonic evaluation of or consultation with a patient." Physicians could use telemedicine when initially treating patients if the patient is already at a medical setting, such as a hospital or clinic, and another healthcare provider is with them to assist.

Teladoc, Inc, whose physicians will perform more than 525,000 telehealth visits this year, sued the Texas Medical Board for anticompetitive actions that will lead to "higher prices, reduced choice, reduced access, reduced innovation and reduced overall supply of physician services."

US District Judge Robert Pitman in June granted Teladoc's request for a temporary restraining order to block the board's new rules. The injunction will continue until Teladoc's federal antitrust lawsuit against the board is resolved.

The Texas Medical Association (TMA) "is sorely disappointed with the court's decision allowing the writing of prescriptions for dangerous drugs without first establishing a patient-physician relationship," TMA president Tom Garcia, MD, said in a statement. "Protecting patient health and safety and improving the quality of patient care are the Texas Medical Board's responsibilities."

The American Academy of Pediatrics (AAP) also opposes virtual visits with physicians who have not previously seen patients in person. In an article in its July 1 issue of Pediatrics, the AAP said, "The use of telemedicine care by virtual health care providers, such as those linked to retail-based clinics…can undermine the basic principles of the patient-centered medical home model."

The AAP said that these virtual visit services provide episodic care without the physician having access to the patient's medical record. As a result, they don't supply the same quality of care that would be provided in office visits, and they interrupt the continuity of care. At a societal level, they result in increased fragmentation of care, incomplete or redundant services, and a waste of healthcare dollars.

Reid Blackwelder, MD, president of the American Academy of Family Physicians, told Medscape Medical News last summer that virtual visits should be "available only to established patients who previously received care from a physician practice."

The American Medical Association's (AMA) policy allows remote visits in some cases without a previous face-to-face meeting between a physician and a patient. At the AMA's June meeting, a proposal that would have expanded the range of permissible telemedicine visits was tabled to allow for more discussion after some delegates opposed it.

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