Hello Walgreens, Walmart, and CVS Health

Access to affordable and preventive health care is important. Retail clinics are surging and care is transitioning away from the hospital and doctors office to fill a void for many Americans who cannot afford to buy traditional health insurance. Some Americans can’t qualify for coverage under the Affordable Care Act, and others may have fallen between the cracks due to a lack of the Medicaid expansion in their state.

Although, biased about the care they’d prefer to receive and where they’d like to receive it, most consumers are on board with the concept of going to big box stores, grocery stores, and pharmacies for quality healthcare at an affordable price.

In a 2013 Oliver Wyman national consumer survey of more than 2,000 consumers, 77 percent were willing to receive at least one medical or wellness service from a retail establishment. For minor incidents, 36 percent of consumers were interested in receiving care at a drugstore and 20 percent at a grocery store.

Walgreens, Walmart, and CVS Health (formerly CVS Caremark) have each invested in a strategy, which incorporates a business model consisting of different mergers formed with hospitals, physician groups, and nurse practitioners to offer quality affordable healthcare directly to consumers. Health information technology (HIT) has helped to facilitate a smooth transition from traditional visits to the doctor’s office by providing a secure platform for partners to get access to, for the purpose of sharing patient data through electronic health records (EHR).

A new research study from Walgreens found the percentage of visits to Healthcare Clinic locations for preventive services, screening and chronic visit utilization (combined) increased from 4 percent in 2007 to 17 percent in 2013. The study also found the annual percentage of return patient visits to Healthcare Clinic climbed from 15 percent in 2007, to more than 50 percent in both 2012 and 2013. Walgreens has over 400 clinics that offer vaccines, physical exams, and screenings for blood pressure, cholesterol, diabetes, health risk assessment, and influenza.

Walmart has positioned itself to lead the healthcare retail price wars by partnering with hospitals and nurse practitioners from QuadMed to offer primary care services in their walk-in clinics seven days a week, inside Walmart stores. Services include preventive and routine exams such as cholesterol screenings, allergy care, and vaccinations. Employees enrolled in the company’s health insurance plan can pay four dollars for services.

CVS has more than 900 “MinuteClinic” locations, and it plans to expand over the next few years. CVS recorded $126.7 billion in sales during the last fiscal year, and is making headlines now because of the decision to stop selling tobacco products by October 1st. This was a brave proactive decision for preventive care.

Going forward, it will be interesting to see the primary care service line for each of the retail clinic chains. Perhaps, the next frontier could include possible alliances and partnerships with board certified sleep specialists and accredited sleep centers. Perhaps each company could consider offering sleep apnea screenings with portable home sleep study devices to consumers in rural and urban demographics where physician shortages exist, and where there are higher disparities for medical conditions such as diabetes, high blood pressure, heart disease, and cancer.

Has your sleep center team explored this prospect? I’d love to read your feedback, albeit positive or negative.



Commercial Drivers ‘STOP’ Drowsy Driving

Alert commercial drivers are an essential component of a safe transportation system, which includes business logistics strategies for the optimal distribution of goods and services. Yet, they are more likely to drive drowsy according to data from the Centers for Disease Control (CDC). Drowsy drivers are less attentive. They have a slower reaction time, and a decreased ability to make decisions.

Trucking accidents are on the rise because most commercial drivers work long shifts, drive long distances, or suffer from sleep apnea. According to the National Institutes of Health, adults need 7 or 8 hours of sleep a day, while adolescents need 9 or 10 hours.The National Highway Traffic Safety Administration estimates that 2.5% of fatal crashes and 2% of injury crashes involve drowsy driving.

Drivers who drive long distances and work long shifts should try to create a relaxing bedtime routine in an environment that is comfortable and cool, and blocks out all light and noise. They should also know the signs of obstructive sleep apnea (OSA) which occurs due to a blockage in the upper airway that interferes with the ability to breathe normally. OSA may contribute to tiredness, excessive daytime sleepiness, mood swings, memory loss, and problems concentrating while performing various routine activities.

If OSA symptoms are present, the driver may use the STOP questionnaire. It is a concise and easy-to-use screening tool that can identify patients with a high risk for OSA.

Four questions are answered respectively, related to snoring, tiredness during the daytime, observed apnea, and high blood pressure (STOP).

High risk for OSA is determined by answering yes to two or more questions. The driver should consider making an appointment with a board certified sleep specialist who will determine if a sleep study is necessary if there is a high risk for sleep apnea, which can lead to high blood pressure, diabetes, stroke, and cancer.

STOP Questionnaire for Obstructive Sleep Apnea (OSA)

Height: _________ inches Weight: _________ lbs

Age: _______ Male / Female Body Mass Index (BMI): _________

Collar size of shirt: S M L XL or _________ inches

Neck Circumference: _________ cm


The STOP test consists of four questions:

  1. Snoring

Do you snore loudly (louder than talking or loud enough to be heard through closed door)?

Yes No

  1. Tired

Do you often feel tired, fatigued or sleepy during the day?

Yes No

  1. Observed

Has anyone observed you stop breathing during your sleep?

Yes No

  1. Blood Pressure

Do you have or are you being treated for high blood pressure?

Yes No

High risk of OSA: answering yes to two or more questions

Low risk of OSA: answering yes to less than two questions

*Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., Shapiro C. (2008). STOP questionnaire. A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108 (5), 812-21.

Venous Insufficiency and Obstructive Sleep Apnea

For the most part, you’re a healthy person. You get your annual wellness exams and live a reasonably satisfactory lifestyle. You manage a career, along with family matters and extracurricular activities that are important to you.

Lately, you’re experiencing swelling or edema in your legs, feet, or ankles, which is usually caused by an increase in interstitial fluid volume. Being the health conscious person that you are, you follow-up with your physician and the diagnosis is venous insufficiency, a condition in which the veins have problems sending blood from the legs back to the heart.

Your physician proceeds to order a complete workup to rule out cardiovascular disease, peripheral vascular disease (PVD) known to be linked to diabetes, and peripheral arterial disease (PAD). This may include a venous Doppler ultrasound to evaluate blood flow through blood vessels in the legs, to rule out a blood clot in the vein and leaking around the valves of the veins.

Your physician may also order a sleep study to determine if you have sleep apnea. Sleep apnea occurs due to a blockage in the upper airway and can cause pulmonary hypertension, which is a common cause of leg edema. The most likely cause of leg edema in all patients over age 50 is venous insufficiency. It affects up to 30% of the population. Another type of edema, idiopathic edema, occurs in women under age 50, and is usually associated with the menstrual cycle and conditions related to obesity, depression, and diuretic abuse.

The volume of fluid available for movement from the legs increases with sitting and leg edema. Fluid volume that is displaced from the legs overnight is directly proportional to the time spent sitting during the day, not to physical activity.

Patients susceptible to fluid retention, may have fluid movement from the legs while asleep during the night, which may cause or worsen obstructive sleep apnea (OSA). The fluid increases in the neck and limits airflow in the airway during sleep contributing to cardiovascular disease and other medical conditions.

You may be advised to decrease your salt intake, limit sitting or standing for excessive periods of time, and to wear compression stockings to gently improve the circulation of blood in your legs, and reduce swelling. If you are found to be positive for sleep apnea, you may be advised to use Continuous Positive Airway Pressure (CPAP).

The takeaway…Get moving!