Retail Health & Wellness Innovation, Convergence, And .
Retail health & wellnessInnovation, convergence,and healthier consumers
Can industry convergence andinnovative offerings lead toprofitable health care services andhealthier consumers? Traditionalretailers entering or expanding inthe US health and wellness marketare staking their future on it.
A convergence of powerful external and internal forces– coverage expansion through health care reform,technological advances, rising consumerism,1 retailers’ desirefor increased foot traffic and cross-selling opportunities, andmore – are prompting many retailers to consider broadeningtheir corporate growth strategy to include health andwellness services via in-store pharmacies, health care clinics,health and wellness programs, and other consumer-focusedinitiatives. And while the opportunities for profit and marketshare growth are substantial, there are numerous risks thatretailers should consider.Retail health and wellness trendsThe US health care market is evolving from an increasinglyexpensive, volume-based, acute-care model to a costconscious, value- and population-based model thatemphasizes prevention of health problems requiring acutecare. Population-based health care incorporates education(such as teaching patients to be more health conscious);delegation (for example, retail clinics’ use of nursepractitioners and physician assistants); and intelligent useof data and information systems2 to focus on value overvolume and improve the health outcomes of groups ofindividuals. Retailers (chain drug stores, grocery stores, massmerchandisers, and club stores) are uniquely positioned –both physically and operationally – to capitalize on the ideathat success will be measured by keeping individuals healthy,which can be facilitated by encouraging regular contactwith care providers, improving medication adherence, andmanaging chronic conditions.Among the drivers fueling retail health care’s growth (Figure1), the following are particularly notable: As consumers take on a larger share of the healthcare cost burden, they are becoming more activeand engaged in managing their health. Many seek tocurate their own experience and are approaching healthcare as they do other goods and services.3 Consumerswant greater convenience, service, and support fromtheir health care provider; retailers are disrupting theexisting system by offering care centers with multiplelocations, more hours of operation, lower fees, andaccess to basic diagnostic tests and medical services.4 Medicaid expansion and health care reform(particularly the launch of public health insurancemarketplaces) have led to growth in the insuredpopulation and increased demand for care andmedications. These challenges are further magnified bythe shortage of primary care physicians (PCPs). Retailerscan respond to increasing demand for primary care andoffer services in a convenient and cost-effective mannerto capture a significant proportion of the newly insuredpopulation. Payers are pressuring other industry players tocontrol spending along the health care value chain.In response, some retailers are partnering with careproviders to establish a continuum of care and boostpatient outcomes. Technology integration, such asElectronic Medical Records, may help to address patientsafety concerns and prevent care fragmentation. The cost of branded and generic drugs continuesto increase.5 While this is generating some additionalrevenue for manufacturers, it is coming out of thepockets of payers and/or consumers – both of which arelooking for ways to reduce costs. New devices and applications are being introducedin the marketplace to monitor patients’ physicalconditions (blood pressure, heartbeat, etc.) andimprove medication adherence. Retailers can provideequipment, education, and encouragement for patientsseeking to leverage wearables and other technologies aspart of a healthy lifestyle. The use of telemedicine is on the rise. Given retailers’unique positioning, investments in infrastructureand training may allow them to become a leader intelemedicine, which can assist in increasing consumeraccess (albeit virtual) to PCPs and driving down the costsof care.These and other marketplace drivers are generating a broadarray of opportunities and potential paths for traditionalretailers to enter or expand their presence in retail healthcare. Doing so can help companies increase store traffic,support cross-selling and up-selling, improve the customerexperience, enhance brand recognition, and grow revenueand market share. Three options in particular – retailpharmacies, retail clinics, and health and wellness programs– merit consideration.Retail health & wellness Innovation, convergence, and healthier consumers1
Figure 1A - How is consumerism changing retail and health care? A convergence between retail and health care is driving traditional health care providers to adopt retail approaches tomarketing and customer service, while retailers are increasing their role in health careFigure 1B - What trends is the converged-industry facing? End users’ relationship with health care providers istransforming from the old paradigm of “patient” into anew model of “consumer” Changing dynamics in the marketplace, including healthcare reform, technological advances, and demographicchanges, are having a significant impact on the retailhealth and wellness marketplace Retailers with health and wellness services are realizingbenefits, such as increased foot traffic, increased salesgrowth, improved cross-selling, brand recognition, andenhanced customer experience2Retail health & wellness Innovation, convergence, and healthier consumers
Retail clinicsRetail pharmaciesOperating an in-store pharmacy appears to be a popularfirst step for retailers looking to incorporate a health andwellness area into their existing operations, as evidenced bythe number of industry competitors that have a similar totalof retail stores and stores with pharmacies (Figure 2).Figure 2: Retail stores and retail pharmaciesThrough personal interactions with patients and face-toface consultations, retail pharmacies – in partnership withdoctors, nurses, health plans, and others – are in a strongposition to help shape the consumer-focused health caredelivery system of tomorrow. For example: There is often competition among pharmacies andPharmacy Benefit Managers (PBMs) to offer integratedhealth care services that may help lower costs toconsumers. Pharmacies are expected to continue tobuild out their disease management and diagnosticservices, wellness and medication therapy managementprograms, adherence efforts, and other initiatives as partof their integrated service offerings. Point-of-care testing services are anticipated to surpassimmunizations to drive revenue. Pressure from payersto detect high-cost diseases early will help speed up thegrowth of pharmacy-based diagnostic screening services. In recent years, a highly competitive PBM market hasspurred consolidation among retail pharmacies and PBMproviders. A variety of factors, including effectiveness of specialtydrugs in treating complex health conditions and largepopulations of patients benefiting from certain drugs,are driving up specialty drug costs as a share of totalprescription drug costs. Retail pharmacies can profit fromexclusive formulary strategies and use the specialty drugchannel to drive revenue growth.Retail clinics, health care practices entirely located in a drugstore, grocery store, or mass merchandiser are a primeexample of disruptive innovation in health care.6 Fueledby a growing shortage of PCPs and consumers’ demandfor quality health care that is convenient (proximity andoperating hours) and affordable, retail clinics staffed bymedical professionals (nurse practitioners and physicianassistants) are becoming an increasingly visible andinfluential aspect of health care. The number of retail clinicsites increased almost 900% between 2006 and 2014, from200 to 1,800, and the number of visits increased sevenfoldfrom approximately 1.5 million to 10.5 million in 2012,which represents 2% of primary care encounters in theUnited States.7Retail clinics and urgent care centers can be cost-effectiveand time-saving alternatives to hospital emergencydepartments (EDs) for nonemergency care. It is estimatedthat 13.7%–27.1% percent of all ED visits could takeplace at a retail clinic or urgent care center, with potentialcost savings to the health care system of approximately 4.4 billion annually.8 Patients who visit retail clinics fornonemergency care ideally will have their prescriptions filledat the pharmacy and buy other products while they are inthe store.9 In addition, retailers can use these channels tobetter engage customers and enable them to make healthconscious decisions (e.g., discounts for purchase of healthierfoods, smoking cessation, and medication adherence). Also,the integration of retail clinics and health care technology,such as mobile apps and wearable devices, can createpositive customer experiences and provide a continuum ofcare through data-sharing platforms between clinics andphysicians. There is also a considerable “hidden” benefit toretailers offering onsite clinics: Internally delivered healthcare and wellness services can drive down associatedcosts for both the company and its employees. These costsavings are likely to become increasingly important, as theAffordable Care Act will impose an excise tax on high-costhealth plans (often called the “Cadillac” tax) beginning in2018. These health plans’ premiums are paid for mostlyby employers, with low, if any, deductibles and little costsharing for employees.10Retail health & wellness Innovation, convergence, and healthier consumers3
The scope of services offered at retail clinics has gone beyond flu shots, acute illness services (sore throat, fever, andinfections), and routine health exams to include preventive screenings, chronic disease management (diabetes, asthma,hypertension, and cholesterol), infusion services, and more.US retail clinic sales are estimated at more than 1 billion and are expected to continue expanding through 2019.11Deloitte’s 2015 health care consumer survey12 shows that retail clinics’ convenience, speed, and cost are driving consumerinterest and usage. The trend of aligning clinic use with incentives from health insurers is also likely to increase their appeal.In the past, consumers often paid out of pocket to visit these clinics, but many can now use insurance coverage to payfor services. Today, more than four in five visits to retail clinics operated by major pharmacy retailers are covered by healthinsurance13 (although consumers typically bear some costs in the form of co-pays, deductibles, etc.). Health plans may beexpanding coverage, in part, because they see retail clinics providing higher quality and lower cost services. In addition,more clinics have hired nurse practitioners and physician assistants.14While the business case for entering the retail clinics market may appear attractive, sustaining performance and realizing thebenefits of this strategy require a clear understanding of clinics’ operational complexities, dedicated leadership, and strongsenior executive support.4Retail health & wellness Innovation, convergence, and healthier consumers
Retail clinics: Convenience, speed, and cost appeal to consumersDeloitte’s 2015 Center for Health Solutions Survey of US Health Care Consumers15 shows that retail clinics’ convenience,speed, and cost are driving consumer interest and usage.Retail clinic drivers*Deloitte Center for Health Solutions Survey of US Health Care Consumers, 2015Willingness to use retail clinics, if.*Deloitte Center for Health Solutions Survey of US Health Care Consumers, 2015Retail health & wellness Innovation, convergence, and healthier consumers5
Health and wellness programsRetailers increasingly are incorporating health and wellness programs that affect and improve consumers’ lives into theirretail offerings. Creating customized “wellness experiences” for each consumer type allows companies to expand their retailhealth offerings and differentiate themselves from competitors (Figure 3).Figure 3: Designing the “wellness” experienceRetailers are looking at ways to offer wellness services that impact and change consumer lives to capture more of the retailmarket by customizing the “wellness” experience for each consumer type.Fit & ActiveGains & ImprovementsHolistic & FullyInvestedConsumers who have a foundationin wellness and have wellnessproduct needs and wantsConsumers who want to changetheir lifestyle and better themselvesvia wellness activities and offeringsLoyal consumers and customerswho are fully committed to allaspects of the “wellness” programRetailers are also seeking to differentiate their "wellness" experience from their retail competition.Providing SupportOffering Services(Step 2)(Step 1)Providing wellness services (e.g., yoga and fitnessclasses/instruction) allow for major differentiationwithin the retail industry. This will engage andencourage consumers, build trust, and create loyaltyAssisting customers with questions about wellness, andhelping them to track personal information viatechnology creates brand awareness and continues tobuild brand loyalty among consumersRetailers also are finding ways to engage and encourage customers by offering yogaand fitness classes, healthy meal planning tips, and information on how lifestyle choices(exercising and smoking cessation) can impact customer health. By offering programs,advice, and coaching, retailers can play an active role in customer health management and,in the process, build trust and create loyalty.6Retail health & wellness Innovation, convergence, and healthier consumers
systematically.17 Individual retailers also are takingsteps. For example, some retailers are establishingrelationships with local physicians and hospitals to helppatients get the right level of care.18Thinking of entering or expandinginto health and wellness? Risksand considerations2.Billing-related financial risksNo matter how successful retailers are in theirtraditional market, health care is a very different world,especially when it comes to getting paid. Dealing withgovernment and third-party payer reimbursementprograms may require different payment systemsfor pharmacy and clinic operations. Also, unlike atraditional retail sale, payment for a health care servicemay not be received until months after a transactiontakes place, which can affect cash flow and revenueforecasts. To further complicate matters, contractrequirements may sometimes affect the ability of theretailer to collect some or all of the revenue from payerorganizations.3.Regulatory risksThe regulatory requirements for a retail health andwellness program vary by state, and federal regulationsadd another level of complexity. Among challenges toovercome are scope-of-practice rules (e.g., some statessay each clinic needs an on-site physician, while otherspermit a nurse practitioner onsite and a physicianon the phone); Health Insurance Portability andAccountability Act (HIPAA) patient privacy rules; ClinicalLaboratory Improvement Amendments for laboratorytesting; Drug Enforcement Administration prescriptionrequirements for controlled and noncontrolled drugs;and lack of government reimbursement for certainservices (e.g., Medicare only covers reimbursementsfor telehealth in limited settings and never in retailclinics).194.Data sharing and security risksWidely reported data breaches at major retailers andpotential security risks around sensitive ProtectedHealth Information (PHI) make proactive dataprotection efforts imperative for retail health providers.For example, patient data on in-store clinic visits canprovide companies with valuable insights on upsellingopportunities, but HIPAA regulations do not allowthe retail side of an organization to access healthcare data. Also, with more retail clinics connectingElectronic Health Record (EHR) systems and otherwiseintegrating data systems with providers and payers,20the potential for security threats increase.The opportunities for growth in retail health and wellnessare considerable. Retail clinics, for example, represent just2% of all primary care encounters in the United States, eventhough the cost of care at a clinic is about one-third that oftraditional outpatient settings.16 However, retailers face anumber of risks when entering or expanding in a market ascomplex, costly, and highly regulated as health care.1.Quality and patient safety risksAs retail health and wellness operations increasein number and scope, key stakeholders – includinginsurers, government, mainstream providers, andconsumers – will be closely watching for potentialnegative quality and patient safety issues. Preventionis the watchword: Federal and state governmentsand industry groups are establishing evaluation andmonitoring programs to promote quality standardsfor nontraditional health care operators. One exampleis Patient-Centered Connected Care Recognition,established in 2015 by the National Committee forQuality Assurance. The program recognizes ambulatorycare providers that communicate and connect withprimary care providers as they deliver care to sharedpatients. Among program requirements: the siteconnects with, and shares information with, primarycare providers; directs patients to appropriateproviders; uses evidence-based decision support andcollaborates with patients to make care decisions;uses electronic systems; and monitors performanceRetail health & wellness Innovation, convergence, and healthier consumers7
Partner or go it alone?Some retailers are targeting the health and wellnessmarket because their competitors are either partneringwith providers and/or payers to offer in-store services orare “going it alone.” Rather than take a follow-the-leaderapproach, new or expanding players should determinewhether or not health and wellness aligns with their overallstrategic vision. Among questions to ask: What kind of operational model do we prefer? Do wewant to build our own clinic and assume all of the risks?Or should we partner with an established health careprovider?ConclusionIt remains to be seen how well retail establishments willbe able to fully integrate with health care providers toimprove care coordination and engage payers to offerreimbursement for a greater number of services, includingin-store pharmacies, retail clinics, and health and wellnessprograms. However, many retailers are positioningthemselves to address the current and future health careneeds of a large section of the US population, significantlyreduce the overall costs of care, and grow their bottom line. What are the risks to our organization of partnering?How will it affect our brand and reputation? Doespartnering conflict with our overall strategy? What do our customers want and expect from us? Who are our competitors in this space? What do we want to get out of this new market(expanded geographical footprint, more sales per store)? What is the breadth of services we want to offer – flushots and other low-dollar services or diabetes/COPD/asthma specialty services? If it is the latter, what is ourvalue proposition versus others offering those services? Do our existing stores have adequate floor space to adda pharmacy or retail clinic? How do we obtain referrals from area health plans andproviders? What upgrades will we need to make to our billingsystems and processes? How do we communicate and collaborate with patients’PCPs, specialists, and health plans to provide seamlesscare?Until a retailer can answer these questions, it might want tohit “pause” before operationalizing its health and wellnessofferings.8Retail health & wellness Innovation, convergence, and healthier consumers
ContactsThomas DelegramDeloitte Advisory DirectorDeloitte & Touche LLP 1 412 596 1078tdelegram@deloitte.comMatthew HourinDeloitte Advis
4 Retail health & wellness Innovation, convergence, and healthier consumers US retail clinic sales are estimated at more than 1 billion and are expected to continue expanding through 2019.11 Deloitte’s 2015 health care consumer survey12 shows that retail clinics’ convenience, speed, and cost are driving consumer interest and usage.
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Figure 4 - Percentage of Employers with Wellness Programs Using Participation and Results-Based Incentives for Selected Health Behaviors The 7 Best Reasons to Have a Wellness Program: Benefits of Wellness [7] 1. Wellness Programs Improve Employee Health Behaviors 2. Wellness Programs Reduce Elevated Health Risks 3.
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In Unconditional Convergence (2011), Dani Rodrik documented that manufacturing industries exhibit unconditional convergence in labor productivity. We provide a novel semi-parametric specification for convergence equations and show that the pace of convergence varies systematically with country-specific characteristics.
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