CVS MinuteClinics are adding chronic care management services, including diagnosing and treating obstructive sleep apnea.
CVS Health has had walk-in medical clinics in its retail pharmacies since 2006. These MinuteClinics focus on diagnosis and treatment of one-off ailments such as strep throat and ear infections, as well as offer some preventative care such as vaccinations.
MinuteClinic care has historically been for illnesses that are either self-limiting and don’t require professional intervention or those that would have warranted a visit to a primary care physician. Just over a thousand MinuteClinics are in operation (among 9,900 total CVS retail locations).
But, post-Aetna-acquisition, CVS is expanding its in-store medical clinics to manage chronic conditions too. And obstructive sleep apnea is on its radar.
“We can actually do a better job in our retail pharmacies in stores than has been done by the healthcare system generally,” said Troy Brennan, MD, CVS Health’s executive vice president and chief medical officer, at a videotaped session at its 2019 Forum. “We recognize the behavioral fact that exists, which is: convenience is king.”
In a video posted to CVS’ payor solutions’ site, Brennan characterizes the diagnosis and treatment of obstructive sleep apnea (OSA) as cumbersome for the patient, including “very difficult” hospital parking, spending a night away from home, waiting weeks for results, and languishing for even more weeks for a device and mask fitting by a durable medical equipment provider. He said, “You’re going to have innumerable places where basically somebody who really isn’t seeking the care is going to fall off.”
In contrast to the “4 or 5 months” of the traditional care pathway, Brennan says CVS’ solution takes about 8 days. Piloted at 3 locations and rolling out into many more, the CVS sleep apnea care pathway involves an in-store screening, home sleep test prescription signed by a nurse practitioner, the patient taking the test at home, followup in-store, and, in many cases, in-store device and interface setup. (Stores that have CVS’ new “HealthHUB” concept, which dedicates more floor space to services and less to retail, will have sleep apnea equipment available.) Due to the comorbidities associated with OSA, “An average pulmonologist would agree: We’re going to treat more people and lower our overall healthcare costs,” Brennan said.
Should an average pulmonologist be worried about CVS usurping your patient base? Probably not. Almost 1 billion people worldwide have the sleep-breathing disorder, according to a study published in The Lancet Respiratory Medicine, and most of those remain undiagnosed.1 What’s more, a study published in 2016 found that more than half of retail clinic visits (58%) represent new utilization; only 42% represented substitution.2 So many of these are people who would never have sought care for their ailment otherwise.
But should you share CVS’ concern about sleep apnea patients who aren’t reaching the treatment stage of the care pathway? Absolutely.
Sleep specialists should ask: What can we do ourselves to streamline care? A walk-in retail clinic that manages dozens of diverse ailments isn’t going to have the deep knowledge that sleep specialists can offer. But first, patients must be able to actually access your care.
Sree Roy is editor of Sleep Review.
1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687–98.
2. Ashwood JS, Gaynor M, Setodji CM, et al. Retail clinic visits for low-acuity conditions increase utilization and spending. Health Aff (Millwood). 2016 Mar;35(3):449–55.