Recently, CVS Caremark announced that starting October 1, they will no longer be selling tobacco products, including cigarettes, in their CVS stores. Taking a bold and unexpected stance on the issue, CVS’s CEO Larry Merlo reasoned to ABC News that “We’ve come to the conclusion that cigarettes have no place in a setting where health care is being delivered.”
What does he mean by that?
Here, he is referring to CVS’s robust market of retail clinics, MinuteClinics. Retail clinics, or the clinics nestled within large grocery store and pharmacy chains (think Target, Walmart, Walgreens), first popped up about 10 years ago and have grown to provide an estimated 6 million patient visits per year at the more than 1600 sites nationwide. Of those 1600 sites, MinuteClinics make up the largest share of the market, with more than 800 clinics. Staffed by nurse practitioners, they are touted as the convenient and cheap answer to the shrinking primary care physician work force. You can make a visit without an appointment, be seen by a health care provider without insurance, and even buy some handy items on the way out. Now, it seems, those handy items will no longer include cigarettes, at least at CVS and Target, which hasn’t sold tobacco products since 1996.
In light of the Affordable Care Act, and the millions of Americans who will now be seeking a primary care home, it seems CVS is positioning themselves to really contend in the new health care marketplace. But the real question is, what does it mean to brand a corporation as a health care organization? If the brand is dependent on messaging, is banning cigarettes enough? Furthermore, is there any conflict of interest when a health care organization is seated within a business whose primary objective is to sell you things?
While we can debate about whether the current reimbursement incentives in health care (i.e. how much clinics, hospitals, physicians, and other health care providers are paid by insurance companies to provide various services including clinic/hospital visits, laboratory tests, and imaging studies) encourage over-selling or the inappropriate use of medical tests and services to make money; I think we all can agree the goal is to create incentive structures that reduce the costs of health care, not conflate them with other retail purchases.
Although CVS’ statement today is estimated to cost them about $2 billion dollars a year in profits from tobacco sales, perhaps the biggest cost will be to our health care system as it seeks to provide coordinated, primary care services, to new populations and the standards for the landscape of those services remains unclear. In my mind, while promoting tobacco cessation is extremely important, the standards for health care organizations must be extremely high if we are to provide the best care to all Americans. As my colleague Dr. Vartabedian pointed out in his blog, 33 charts, why does CVS not also ban high sugar, high calorie food and drinks, like chips or soda? There is ample evidence to show that consumption of these items increase one’s risk of disease and early death. In addition, the convenience of the model makes retail clinics particularly apt to care for underserved and poor populations, and yet they have yet to really reach out to and be utilized by these groups.
The bottom line is, retail clinics could be an innovative solution to providing care to diverse populations in new and affordable ways. But to truly be a health care organization, the messaging around health and wellness has to be consistent, clear, and free of commercial bias. Hopefully, banning cigarettes is just the start but as it seems to me, CVS still has a long way to go.