Good Fortune: 10 trends to watch in 2014

Rather than take vacation for Christmas and New Year’s, the editors of DSN worked to compile a list of the top 10 trends that will shake up the business in 2014.

Clinics explode onto scene

Keep a close eye on retail-based health clinics come 2014.

The convenient care industry has come far since hitting the scene in 2000 and today — with nearly 1,500 clinics nationwide — they are proving their importance within the changing healthcare landscape.

For clinics, 2014 will signal a massive expansion of the acute care model — supporting primary care, lowering costs and improving patient outcomes.

Managing provider risk

Both government and private payers are pushing the development of such new delivery systems as patient-centered medical homes and accountable care organizations. In addition to shifting payment models, providers also will be required to assume more risk.

This will fuel the growth of a new customer group: providers. Consider some of the innovative, team-based healthcare partnerships that have already begun to emerge: CVS Caremark is working with providers and case managers of HMSA, Hawaii’s Blue Cross Blue Shield program, to share adherence and gaps in therapy data. Also, MinuteClinics on Oahu are linked to HMSA’s medical homes, helping to coordinate acute and chronic care.

Meanwhile, Walgreens in October partnered with the ACO Baroma Health Partners in the Miami-Dade, Fla., area. Baroma will use Walgreens’ WellTransitions program to help reduce hospital re-admissions and improve adherence.

Shifting patient segments

Health reform will result H1 in newly covered lives, new sources of funding and massive shifts between patient segments. By 2016, it is expected that 17 million of the previously uninsured will enter the healthcare system either through the private exchanges or Medicaid, which is expected to grow 24% in that time, adding 11 million more lives. It also is expected that a number of employers will begin to shift retirees into Medicare (up 18%) and move current employees into the private exchanges (up 150%).

Generics — surge and scale

As the industry heads into the backstretch of the great generics surge, with more than $30 billion worth of blockbuster drugs expected to go generic in the next two years, 75% of prescriptions carrying a co-pay of less than $10, and a massive wave of generic commoditization expected to follow as the big introductions dry up and margins tighten, big pharmacy retailers and wholesalers are forming new alliances to grow purchasing scale and optimize profitability.

While New York hedge fund Elliott Management remained a hold-out on the McKesson-Celesio deal announced in October — the fund owns 25% of Celesio shares — assuming the deal gets done as planned, the top three generic purchasers, according to Pembroke Consulting president Adam Fein, will be AmerisourceBergen/Walgreens/Alliance Boots ($12 billion); McKesson/Celesio ($11.5 billion); and CVS Caremark/Cardinal ($10 billion).

Offering same-day delivery

According to a PricewaterhouseCoopers poll of 11,067 online shoppers, fast delivery was a top driver behind online spending. And what can be faster than same-day?

Walmart is already offering same-day in five markets. And according to a RetailNet analysis, AmazonFresh’s same-day delivery service may be able to reach as much as 80% of the population eventually, and as much as 50% in the next 36 months.

Same-day delivery will open new categories to the online shopping experience, particularly incidence-driven categories like cough-cold or pain relief. According to Boston Consulting Group, more than 66% of respondents said they would pay $5 or less for the same-day delivery of beauty and healthcare products.

Legalizing marijuana

Before it was banned in 1937, marijuana was used widely as a medicine. Today, the federal government views it as medically useless. But 20 states and the District of Columbia disagree and have legalized medical marijuana sales at special dispensaries.

At press time, legislation to legalize medical marijuana dispensing at pharmacies, pending federal approval, had passed in Michigan’s state legislature and was awaiting Gov. Rick Snyder’s signature. Such legislation had the support of 61% of the 874 respondents to a DSN online poll. According to a poll last month from TheStreet, 69% of respondents said that marijuana, if legalized, should be sold at pharmacies.

Expanding provider roles

How can the nation further battle an ongoing physician shortage, rise in chronic diseases, an aging population and the implementation of massive health reform? Provider expansion.

This is already playing out in the retail clinic space, as clinic operators expand services into chronic disease, preventive care and biometric screenings.

Meanwhile, DSN also expects more states to follow the lead of California in expanding provider status to pharmacists. The new state law, which took effect Jan. 1, authorizes pharmacists to administer drugs, including by injection; provide consultation, training and education about medications, disease management and disease prevention; participate in multidisciplinary patient reviews; order and interpret tests to manage and monitor drug therapy; and via state protocol, to independently provide hormonal contraceptives, travel medications and nicotine-replacement products.

Specialty spending poised to continue rise

Specialty pharmacy spending continues to climb — and a growing number of retailers are gearing up to snag a bigger piece of a growing pie.

According to IMS Health, spending on specialty drugs is expected to reach $193 billion by 2017, with specialty drugs “dominating” new drug launches and accounting for a projected 8-of-10 of the top branded drugs in the United States — up from 3-of-10 in 2010.

Payers will look for more solutions that lower cost.

One area DSN expects to see increased activity is home infusion — an $11 billion market and growing at about 10% a year at present. And as payers become more focused on site-of-care management, the growth curve could sharpen significantly in the years ahead.

The technology factor

Another area in which DSN expects to see continued activity is in pharmacy-related technology. Consider just these three areas:

  • Health kiosks: According to a fall 2013 Price-waterhouseCoopers study, about 41% of consumers say they would like to be able to access some form of “do-it-yourself health-screening station” at their retail pharmacy.
  • Health apps: According to an IMS study of the 43,000 health and wellness-related apps available, fewer than half were directly related to patient health and treatment. According to a 2013 Journal of America Pharmacists Association study, only about 160 adherence-related apps were available.
  • Telehealth: Consulting firm Towers and Watson estimated that 25% of employers would offer telehealth options to beneficiaries by 2013. Rite Aid continues to grow its telehealth-powered Now Clinics, which now number more than 70 locations.

Retail’s perfect ‘attendants’   

A growing number of pharmacy retailers are hiring store attendants. Walgreens has its health guides at many of its Well Experience-format stores and some 26,000 beauty advisers; Rite Aid has its 1,900 Wellness Ambassadors and is now hiring beauty advisers for its Beauty Vision pilot; and Target has grown its Beauty Concierge program to nearly 300 stores. A look at the response from customers explains why in-store service will continue to be a trend in 2014. Rite Aid found early on that stores with Wellness Ambassadors did better than those without.   

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