Major pharmacy chain and retailer investments in primary care and implications for access to and quality of care in older adults - PROJECT SUMMARY/ABSTRACT Access to high-quality primary care providers (PCPs), including physicians and advanced practice providers, is associated with better patient outcomes and is necessary to coordinate the complex needs of an aging population. Currently, primary care is experiencing significant corporate investment, which may have important implications for access to and quality of care in older adults. One key subset of investments has been from major pharmacy chains and retailers that own pharmacies. In the last five years, Walgreens invested over $6B to acquire majority stake in VillageMD, CVS acquired Oak Street Health for $10.6B, Walmart opened 51 Health Centers, and Amazon, which operates a mail-order pharmacy, acquired One Medical for $3.9B. In testing care models, these firms have acquired, opened, and closed many clinics, which are collectively referred to herein as retailer-owned primary care clinics. An important portion of these clinics focus on older adults, as firms see an opportunity to profit in value-based contracts in Medicare. Yet, the implications of retailer-owned primary care clinics for access to and quality of care in older adults is uncertain. The overall objectives for this proposal are to examine the implications of retailer-owned primary care clinics for access to and quality of care for older adults (age 65+). Through the proposed training plan, which includes formal coursework, workshops, and clinical shadowing, as well as a multi-disciplinary mentorship team of NIH-funded investigators, Dr. Kakani will gain clinical knowledge on primary care in older adults and on medication management of chronic disease, expertise in qualitative and mixed methods, and expertise in advanced statistical methods for causal inference. Dr. Kakani will use the knowledge gained through training activities to achieve the following specific aims: (1) Compare the area, PCP, and older adult patient characteristics of retailer-owned primary care clinics to other primary care practices to identify implications for access to and quality of care, (2) Evaluate the impact of retailer-owned primary care clinics on access to and quality of care for older adults, and (3) Characterize the perspectives of health care executives and PCPs of retailer-owned primary care clinics and specialist physicians treating patients using retailer-owned primary care clinics regarding factors impacting care delivery for older adults. This application is innovative because it will be the first study of retailer-owned primary care clinics and will leverage a mixed methods approach to provide nuanced insights into the implications of retailer-owned primary care clinics for older adults. The proposed research is significant because it will provide new, critical evidence on the impact of retailer-owned primary care clinics, which will inform innovators and policymakers seeking to reform and improve access to and quality of primary care in an aging population, and regulators of mergers and acquisitions in health care. This to access K01 Award will also provide Dr. Kakani with the training and mentoring needed become n R01-funded independent investigator leading a research program on primary care and medication and management in older adults. a
