CVS to offer primary care in Houston

Retailers' grand plans to enter the primary care market have so far been unsuccessful. But CVS Health believes it can succeed where others have stumbled -- and Houston is serving as a testing ground.

The pharmacy giant launched in-network primary care earlier this year at MinuteClinic locations in Houston and San Antonio, and it has since expanded to markets in Florida, Georgia and North Carolina with more expected in 2025. The program is currently limited to certain Aetna health insurance plans, but CVS Health is in discussions to add additional payors.

The effort is the latest attempt by a major retailer to enter the primary care market in recent years. The goal is to make primary care providers -- the medical professionals who patients see for annual check-ups and health concerns that are not emergencies -- more accessible.

But competitors such as Walgreens and Walmart have already abandoned or scaled back their forays into primary care, citing the challenges associated with entering the market. CVS Health believes it can succeed because it has built MinuteClinic into a "household name" in health care, said Dr. Creagh Milford, the president of retail health at CVS Health.

"The fact that it's a proven model, with two decades of really good outcomes, I think is pretty differentiated from our peer group," he said.

Retailers have thus far struggled to adapt to the challenges of entering the primary care market. Navigating the health insurance landscape is complicated, and the reimbursement rates that providers are paid by insurance companies are lower for primary care compared to other services. Providers need to establish a steady base of patients to make a practice sustainable, said Dr. Kirsten Meisinger, the director of leadership and system transformation at the Harvard Medical School Center for Primary Care.

"[Retailers] thought they could just take better care of people, and the profits would follow," she said. "But that, in fact, is not the case for primary care."

Experts noted that CVS Health has one clear advantage. It owns Aetna, which reduces the uncertainty of negotiating reimbursement rates for primary care providers.

Milford said CVS Health has the infrastructure in place to succeed in primary care. MinuteClinic already offered many of the services that patients turn to primary care for, such as wellness exams and chronic care management.

Moving into primary care was the "last mile" for the health clinics, Milford said.

"We already have the clinics. We already have the care teams. And we have a pretty large, loyal patient base that trusts CVS," he said.

The appeal

Many retailers were keen to establish primary care because they saw an opportunity to fill a need for more access.

The Texas Department of State Health Services has projected the state could face a shortage of about 10,330 doctors by 2032, including in all primary care specialties such as family medicine. The same trend has been seen nationwide, as the American Medical Association has projected a shortage of between 20,200 and 40,400 primary care physicians by 2036.

The shortage of doctors means that many are taking on increased workloads, which can lead to burnout. Nurse practitioners and physician's associates can also provide primary care and have been instrumental in easing the burden.

Companies like Walgreens, Walmart and Amazon have sought to enter the health care market, including primary care, but those efforts have often been unsuccessful.

Walgreens piloted its partnership with health care provider VillageMD in Houston and had planned to have 600 primary care locations by 2025. But it has since closed dozens of underperforming clinics, and the company said it is considering selling its stake in VillageMD.

Walmart opened health centers in the Houston area earlier this year as part of a push into the health care space. But the company reversed course just months later and announced it was permanently closing all locations.

Those disappointments show how difficult it is to enter the market, said Benjamin Ukert, an assistant professor in the Department of Health Policy & Management at Texas A&M University.

"[Retailers] are just not aware of how tough it is to establish an infrastructure in the health care space if you don't have an existing footprint," he said.

Primary care at CVS

CVS Health, on the other hand, bought the primary care company Oak Street Health last year and has been working to expand the clinics, which are primarily used by seniors, across the U.S. The company also has more than 1,100 Minute Clinic locations nationwide.

Unlike its competitors, CVS Health did not need to build clinics or grow a base of patients, Milford said. It also had some health care workers in place, though it had to hire more. The effort has also included adding services such as EKG, implementing more training and upgrading the system it uses for electronic medical records.

MinuteClinic exam rooms look like a typical doctor's office, outfitted with a medical bed and an eye exam chart on the wall. The health clinic's primary care providers are nurse practitioners and physician's associates, but they are overseen by doctors, Milford said.

CVS Health believes its entry into primary care can help improve access for patients. Many MinuteClinic patients are young do not have a primary care provider, said Serena Lopez, a nurse practitioner lead for 15 of the health clinics in the Houston area.

"They tell me time and time again that I may have a doctor, but I can't get an appointment, and I come to you because you're open late and you're open weekends and holidays," she said.

The company is promising primary care appointments as soon as the next day, Milford said. The Chronicle checked its website and found plenty of appointments available at Houston clinics.

"Given our size and scale across most of the communities we serve, I think that we have a pretty tremendous opportunity to drive much greater access," Milford said.

Will it be successful?

Experts said they believe CVS Health is in a better position to succeed than its competitors, at least in the short term.

Aetna is one of the largest commercial health insurers in the United States, accounting for 11 percent of the market in 2023, according to a report by the American Medical Association.

CVS Health could entice those patients to use MinuteClinic for primary care with incentives like low or zero copays, Ukert said. CVS Health said copays for primary care visits vary, but it did not offer specifics.

"They can incentivize [Aetna members] to seek care at these clinics," he said.

CVS Health has been "extremely thoughtful" in how it has grown MinuteClinic over the years, Meisinger said. The company has also built trust with patients who have turned to MinuteClinic for things like a flu shot or COVID-19 vaccine, she said.

"I'm cautiously optimistic that they could succeed where others have failed," she said.