CVS Health is stationing therapists at some of its nearly 10,000 retail stores, in a move to increase patient access to often overscheduled behavioral health providers.
The services are in-network for all Aetna members, as CVS owns the insurer. The pilot program is available in a dozen stores in Houston, Philadelphia and Tampa, and CVS plans to expand to 34 locations this year in communities where mental healthcare is not readily available.
The initiative represents an extension of CVS' HealthHUBs, which exist in some 650 stores and offer urgent care and wellness products at the same place where a consumer can fill a prescription. By adding a therapist to its care services, the retailer said it aims to increase access in underserved areas and control the behavioral health costs among its 23.4 million members, particularly among young adults and people of color who have experienced "high instances of mental health symptoms and distress, leading to increases in emergency visits" this year.
"CVS Health is offering new access points for populations who are struggling with the unprecedented stressors of recent months, helping to avoid costly ER visits and providing a pathway for symptom relief," Dr. Daniel Knecht, vice president of clinical product at CVS Health, wrote in an email.
CVS' therapists cannot prescribe medication but can treat mild to moderate symptoms of depression, anxiety and create a care plan for members. They can also refer patients back to their primary care physicians, MinuteClinic providers or community clinicians, who can prescribe drugs at their discretion.
The move capitalizes on CVS's extensive retail footprint, said Adam Block, a health economist and former CMS regulator. Like CVS's urgent care facilities, employing a licensed clinical social worker onsite addresses a critical unmet population need, particularly as demand for mental health services rises during the COVID-19 pandemic.
"They're really just expanding the type of healthcare that they're already getting at their pharmacies and trying to leverage these retail properties they already have," Block said. "There's tons and tons of data that people trust their pharmacists, and that brand value is incredibly valuable to CVS and Aetna. They're just building on it a little bit more by expanding what they do."
He noted that one of the most effective ways insurers have at controlling costs is to vertically integrate their business, by adding healthcare providers who agree to payment rates dictated by payers. This strategy has been mirrored across the industry—UnitedHealth Group reportedly employs the largest provider network in the nation, with 57,000 clinicians, and Humana last week announced the close of its $8.1 billion Kindred at Home acquisition, adding some 43,000 home healthcare workers to its network.
While inpatient mental health services are one of the most expensive conditions for an insurer to treat—since individuals generally don't fully recover but also don't die from the disease, and their conditions often come with comorbidities—Block said this initiative could offer preventative care before more severe conditions arise. But he said it was likely more targeted at increasing access.
"Insurers have found that the best way to control things is to have an ownership stake in some of the providers so that they are all working together for the same triple aim, which is cost control, clinical excellence and good customer service," Block said. "It's just happening in slightly different strategic ways."
Insurers have been moving to add behavioral health services as a benefit thanks to demand from employers, who have recognized that the pandemic has taken a toll on their workers' well-being, said Olivia Webb, a healthcare writer. Cigna, for example, recently announced that it was partnering with Ginger to provide virtual behavioral healthcare services to its 14 million individual and employer-sponsored members. Webb said CVS was likely to employ therapists on a contract basis and compete for talent with startups like Ginger, Talkspace and Spyro. She said this will lead to high worker churn, potentially lower quality of care, but also innovations among companies focused solely on delivering the service.
"It may be therapeutic, but it may not be therapy," Webb said.
As different insurers' initiatives unfold, Webb said the market will divide based on the demographic of patients served. She believes that middle-class, white collar workers generally prefer video visits—which several studies have indicated result in the same, or near equivalent, outcomes as in-person care—since they do not require people to travel and can feel more private. Meanwhile, traditional, in-person therapy could become a service for those with high acuity cases, a luxury good for those with money or a necessary component for blue-collar workers who lack easy access to the internet.
Because CVS accepts cash pay patients, and individuals can book in-person or virtual care visits for nights and weekends directly at stores, she said the initiative removes the traditional barriers individuals face when trying to navigate the healthcare system. CVS said its therapists are in-network with other "major insurers and employer assistance benefits plans," although it declined to name which ones.
"The small-town community doctor model is, unfortunately, falling away, and I think that the new model is less personal and, maybe, worse quality, although I don't know if there's enough data to support that right now," Webb said. "But I do think that it's democratizing access."
Dr. Andrea DeSantis agreed that CVS's initiative increases access for patients, particularly those located in rural areas. But the North Carolina-based family physician also noted that it could introduce fragmentation in the healthcare system—and, therefore, increase the administrative burden faced by patients and primary care providers, as well as costs—and, ultimately, lead to more "cookie-cutter" care for individuals.
"When retail starts getting into the act of filling a narrow need, who's gonna hold them accountable if the patient has other health problems?" DeSantis said. "Whose going to hold them accountable if they can't pay their bill? Whose going to hold them accountable if they can't handle something that's out of their league? Where's the warm handoff?"