Massachusetts Health Care Proposal Faces Pushback from Experts

BOSTON — A proposed partnership between Mass General Brigham (MGB) and CVS is encountering significant skepticism from primary care physicians and state health care officials. The collaboration aims to enhance access to comprehensive primary care, but critics question its effectiveness and underlying intentions.

Senator Cindy Friedman, co-chair of the Health Care Financing Committee, expressed her disbelief regarding the proposal, stating, “My first reaction was, this is not what we think about when we think about primary care. I’m kind of blown away.” The partnership seeks regulatory approval for a clinical affiliation that MGB and CVS claim will help lower health care costs and provide services to individuals lacking primary care access.

According to documentation submitted to the Health Policy Commission on June 6, 2023, CVS currently employs about 80 advanced practice providers (APPs) across 37 MinuteClinic locations in Massachusetts. Notably, this proposal does not entail the opening of more clinics or hiring additional staff, nor does MGB plan to invest financially in the collaboration.

Concerns regarding the proposed partnership center around the involvement of physicians. Dr. Chris Garofalo, a primary care physician at Family Medicine Associates of South Attleboro, remarked, “Extending primary care to a business such as CVS through MinuteClinics, which typically only have nurse practitioners, would be a little concerning because it would seemingly remove the physician from the equation.” Garofalo emphasized the importance of having a diverse team in primary care, stating that excluding physicians may not be the best approach.

In Massachusetts, nurse practitioners operate independently of physicians, and CVS asserts that clinicians at MinuteClinic will manage comprehensive care focused on prevention, including health maintenance visits and chronic condition management. The proposed model would allow each clinician to support a patient panel of approximately 1,500 individuals, potentially increasing capacity for up to 120,000 patients statewide.

Dr. Zoe Tseng, a primary care physician at Brigham and Women’s Hospital, raised doubts about the feasibility of the APPs managing such a large patient panel effectively. She stated, “I think it’s highly doubtful that an APP would be able to carry a [full] patient panel of 1,500 and still feel like they could do it adequately.” Tseng, who has been with Brigham and Women’s for 11 years, noted that administrative burdens often force her to work more than 40 hours per week, indicating a lack of adequate support within the current system.

Critics, including Dr. Alan Sager, a health policy expert at Boston University, suggest that the proposal lacks transparency and may merely serve as a facade for increased corporate profits. He characterized the partnership as “more primary care smoke and mirrors,” emphasizing the need for experienced, salaried nurse practitioners who are dedicated to patient care rather than operating in drugstore settings.

The Massachusetts Medical Society, represented by President Dr. Olivia Liao, has urged for careful consideration of any proposals that could impact primary care access. Liao affirmed, “We believe patients receive the best possible care when they are served by a physician-led team, supported by other health professionals.”

The proposal’s review process is set to begin following additional paperwork submissions to the Health Policy Commission. Although the commission cannot outright block the partnership, it can recommend that other state agencies assess its implications. CVS expects a decision from the commission in the fourth quarter of 2025.

If approved, MGB patients would have access to primary care at MinuteClinics, which CVS claims would facilitate enhanced care coordination with MGB hospitals and specialists. However, some physicians worry that adding more patients to MGB’s system could lead to longer wait times for care. Dr. Andrew Cooper Warren, a primary care physician at Brigham and Women’s Faulkner Hospital, cautioned that the affiliation may prioritize business interests over patient needs.

Senator Friedman echoed these concerns, stating, “It’s the continuation of the consolidation of health care and it’s not working for anybody except for businesses who are in the business of health care.” She advocates for systemic reforms to improve primary care access, including reducing administrative burdens and increasing compensation for primary care practices.

Friedman has proposed legislation aimed at establishing primary care spending requirements and developing strategies to stabilize the workforce. While her bill has received favorable reports, it remains stalled in the Senate Ways and Means Committee.

In a broader context, CVS’s MinuteClinic has already begun offering in-network primary care services to some Aetna members across various states, including Texas and California. The ongoing debate in Massachusetts reflects a growing concern over the future of primary care, as stakeholders seek effective solutions to a sector increasingly strained by provider burnout and patient access challenges.