At an April Health Policy Commission meeting, commissioner Martin Cohen worried that the services would be “primary care light at a full primary care cost.”
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Before the Health Policy Commission issues its final report on the proposed transaction in June, it should take a close look at the quality of care CVS provides in other states. Regulators should also consider capping price increases for the first few years.
CVS’s proposal, described in a preliminary report by the Health Policy Commission, is to turn its 37 Massachusetts MinuteClinics into primary care sites. Today, MinuteClinics provide “convenience care” — administering vaccines, testing and treating common illnesses like strep throat, and conducting camp physicals. Under the proposal, those sites would offer a fuller slate of adult primary care services, for example adding chronic disease management and more diagnostic tools, in addition to convenience care. A patient could see the same practitioner each visit and be referred for specialty care. The clinics would not see children for either primary care or convenience care.
The sites would not provide the same care as visiting a full-service doctor’s office. The clinics would not prescribe controlled substances — which could exclude some patients with chronic pain or psychiatric disorders — or treat substance use disorders. Care would be provided by nurse practitioners, who would be overseen by a physician.
The model is relatively new. CVS adopted a primary care strategy in 2024 and has since opened more than 500 primary care clinics in 15 states and Washington, D.C., sometimes in partnership with a local health system.
Success is not assured. Walmart and Walgreens each experimented with offering primary care but backed away when those initiatives weren’t profitable.
Mass General Brigham chief financial officer Niyum Gandhi told the editorial board that MGB has around 1,400 affiliated physician practices, and under this model, CVS would become another affiliate. CVS would hire the clinicians, with MGB providing services like care coordination, data sharing, and tracking quality measures. Patients’ medical records would be shared between providers at each system, and patients could be referred from MGB to CVS practices and vice versa for specialty or follow-up care.
There is a benefit to expanding access to any level of primary care, even if it’s not full-service, particularly, as CVS is promising, in convenient locations with short wait times. “The ideal is we have well-functioning, well-structured teams of primary care clinicians in a variety of settings providing the most comprehensive integrated care possible,” said Asaf Bitton, executive director of Ariadne Labs, a health systems innovation center that’s part of MGB. “The reality right now is that 20 to 30 percent of the state cannot get into primary care when they need it for anything.”
But a big question is what the cost will be. The Health Policy Commission’s preliminary report suggests the transaction would increase spending by commercial health insurers by approximately $40.2 million annually. CVS and MGB intend to dispute the commission’s numbers and methodology in filings due May 15.
Some extra spending may be warranted. If a patient who couldn’t access primary care previously can now get care, that’s a good thing. Spending on primary care can save money later if a condition is treated early.
But if the added cost stems from more patients getting care in more expensive settings, that’s problematic. MinuteClinics today charge some of the lowest rates in the state, while Mass General Brigham is Massachusetts’ most expensive health system. Under the affiliation, CVS would be paid under insurance contracts negotiated by MGB that cover all affiliated practices, at higher rates than CVS is paid for MinuteClinic services. The Health Policy Commission assumes there would be higher costs due to new patients getting CVS primary care; an increase in prices for existing convenience care services; and children who get MinuteClinic care paying more for that care elsewhere. Additionally, any patients referred to MGB for specialty care would be charged MGB’s high prices.
Massachusetts needs more primary care, and it needs to be offered in a way that gives patients quality care at a reasonable price. Before approving this transaction, state regulators should make sure that’s what it will do.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.