Retail health care’s role in an aging America

In caring for older adults, neighborhood health destinations will be as important as virtual care and home health delivery.

If there’s one lesson from the past decade, it’s that older adults are absolutely willing to change how they receive care — if the benefits are worth the effort. Retail health clinics offer a prime example. This channel has always been popular with younger people, with more than a third of millennials using it as their preferred form of provider visit.¹ But patients over 65, who had been slow adopters, are now migrating to retail health care in record numbers and doubled their use in the years before the pandemic.²

Convenience is part of the reason. “It’s challenging to get an appointment with a traditional primary care practice as it can sometimes take weeks or even months to get in to see a primary care provider,” says David Fairchild, MD, MPH, Chief Medical Officer of Retail Health and Senior Vice President and of CVS Health^®. “Retail health clinics provide the accessibility that older adults look for.” In fact, in 2022, more than 650,000 patients aged 65 and older sought care at MinuteClinic^®.

Retail health care can also help with a larger, structural problem: About 13 million people in the United States live in primary care provider “deserts.” According to a 2021 report,³ one full-time primary care provider in these areas must serve more than 10,000 people — a caseload more than three times what’s recommended. And more than a third of U.S. residents face other kinds of health care shortfalls in their area.

Retail and pharmacy providers can provide a lifeline and even flag health issues before they become critical. “Medical problems can worsen in a hurry, particularly in older adults, if people wait too long to engage with a practitioner,” says Dr. Fairchild.

The future of retail health care for older adults

Getting retail sites ready for an aging America will mean changing both practices and mindset. A focus on value-based care, for example, is a key part of that care delivery strategy. “By working with providers and health systems to connect Medicare patients to community MinuteClinics, we’re aiming to close care gaps for vulnerable patient populations and promote health equity while bringing down costs,” says Mohamed Diab, CEO of the CVS Accountable Care Organization.

In 2022, MinuteClinic also completed a three-year program to incorporate an evidence-based approach into visits with older patients. This care model is known as Age-Friendly Health Systems. It was implemented in close collaboration with The John A. Hartford Foundation, Case Western Reserve University Frances Payne Bolton School of Nursing and the Institute for Healthcare Improvement.

Visits for patients over 65 include use of the Age-Friendly Health Systems’ framework known as the “4Ms”: What matters, mentation, mobility and medication. In practical terms, a provider using this framework aims to align care with a patient’s health goals and care preferences (what matters), address mental health and cognitive skills, help them maintain function and mobility and use only age-friendly medications that don’t interfere with what matters, mentation or mobility. More than 465,000 MinuteClinic patients have received this kind of patient care — that’s nearly half a million patient encounters in two and a half years.

“When retail health clinics can screen and identify age-related problems, such as cognitive decline, it provides a safety net,” says Anne Pohnert, DNP, Lead Director of Clinical Quality for MinuteClinic. “Our providers can alert the patient and their primary care physician of a potential risk that might not be detected until the patient’s next visit, which could be months or up to a year away.”

The 4Ms framework also offers a chance to build trust with providers — and sometimes open doors to better care. One patient in Maine had not been to a health care provider in 30 years. Not wanting to go to the hospital, the patient made an appointment at his local MinuteClinic and the provider immediately identified an advanced case of congestive heart failure. While the patient initially refused further treatment, a 4Ms discussion about his health priorities (what matters) ultimately led him and his caregiver to pursue life-saving treatment at a nearby hospital.

Including caregivers in these appointments — and improving access to health records and future appointment scheduling — is another area of innovation. More than a quarter of Americans now consider themselves caregivers, according to a recent CVS Health poll, and many report that it causes a financial and mental health strain. Retail health care providers can help on this front, becoming an ally on a range of age-related topics that might be difficult to address directly with a patient. “The wife of one patient returned to the MinuteClinic to thank the provider for bringing up her husband’s memory issues, which he'd been ignoring,” recalls Pohnert. “Now he’s getting the memory care he needs.”

The local pharmacy will also become more important as a place to check in with older patients and intervene if necessary: Nine out of 10 older adults are taking a prescription medication, with more than half taking four or more prescription drugs.⁴ Patients of all ages already look to pharmacists to answer medication questions and deliver key vaccines. There is movement in the industry to help pharmacists practice at the top of their licenses by exploring the impact of social determinants of health on their older patients — and referring them, when possible, to local resources for help with challenges such as food insecurity or transportation.

Convenience, accessibility, familiarity and trust are all elements that retail health clinics and pharmacies can build on in the decades ahead. “It’s essential that we make older people feel welcome in retail health clinics and show them that they are interacting with a provider they can trust,” says Creagh Milford, DO, MPH, Senior Vice President of Retail Health, CVS Health.