Amazon, Walmart, CVS, Dollar General and other big retailers are elbowing their way into health care delivery, pushing a customized consumer experience driven by digital health products.

What's happening: At its core, these companies are pulling together different tech-enabled services — urgent, primary, home and specialty care, pharmacy, and, in some cases, full integration with an insurer.

Why it matters: A more user-friendly portal to the health system could lead to more engaged patients and better access to care in underserved areas. It could even yield a sustainable model for profitably offering better care for less money.

• But the retailers' forays are prompting growing anti-trust and privacy concerns, as well as fears of further erosion of the doctor-patient relationship once considered central to coordinated care.

Between the lines: Amazon, CVS and Walmart have made some of the most consequential moves by combining their massive retail footprints with assets like primary or urgent care sites, pharmacies and some sort of relationship with insurers, experts say.

• "They're all acquiring every piece of medicine," Robert Pearl, a Stanford University professor and former CEO of the Permanente Medical Group, told Axios.

Between the lines: Each of these businesses also are clearly eyeing a very lucrative segment of health care: Medicare Advantage. More than half of eligible seniors are now covered by privately-run Medicare.

The bottom line: This still makes up a very small segment of health care delivery — and may not solve the medical system's biggest problems.

• "These players ultimately have to deliver the same or better outcomes at a lower cost in order to be in-network and get recommended by payers as well as picked by the employers," said Caroline Hofmann, head of emerging businesses at virtual specialty care company Thirty Madison.
• And, she said, they can certainly increase access. But "it remains to be seen if they can really bend the cost curve."

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Editor’s note: This story has been updated to correct the spelling of Caroline Hofmann’s name.

Here's a look at what some of the major retail brands are doing when it comes to delivering health care.

• Amazon recently acquired One Medical, a membership-based primary care company, adding a tech platform and more than 125 physical locations. The online retail giant also bought pharmacy company PillPack and recently launched a generics subscription service. It also owns Whole Foods.
• CVS Health in January announced a plan to buy Oak Street Health, a value-based primary care group focused on Medicare patients. The pharmacy giant also owns insurer Aetna, pharmacy benefit manager CVS-Caremark, home health company Signify Health, and health care service brands MinuteClinic and HealthHUB.
• Walgreens-backed primary company VillageMD plans to open more than hundreds of full-service doctors' offices in Walgreens locations. VillageMD also acquired primary, specialty and urgent care company Summit Health+CityMD with investments from Walgreens and Evernorth, the health services business of Cigna.
• Walmart Health announced last week that it plans to nearly double the footprint of its in-store clinics, which offer primary, behavioral health vision and dental care. Last fall, it inked a 10-year Medicare Advantage deal with UnitedHealth Group.

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Physicians and other health care providers contend the Biden administration's proposed update to Medicare Advantage payment policies could wind up hurting their practices and patients, Axios' Maya Goldman writes.

Why it matters: With providers joining insurers against the proposed changes, the Biden administration is left with few allies.

• CMS still could reverse course or delay the changes — an outcome that looks increasingly likely as more industry groups voice their discontent.

Driving the news: The Centers for Medicare and Medicaid Services last month proposed an average 1.03% revenue increase for private Medicare plans in 2024.

• But insurers say changes to the MA risk adjustment model, which tweaks plan payment based on enrollees' health and demographic statuses, would result in a net cut next year.
• Insurers and many consumer advocates came out strongly against the policy, and Republican lawmakers accused the Biden administration of effectively cutting Medicare with the proposal.

What they're saying: Providers now say that potential spillover effects from the new policy could hurt their own operations.

• "This proposal likely will reduce payments to plans, and ultimately providers who care for [patients] with chronic conditions," the American Medical Group Association wrote.

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A lawsuit brought by abortion patients in Texas is focusing attention on how some strict state abortion bans could imperil lives by leaving it to providers to prove if a person qualifies for an emergency exception, writes Axios' Oriana Gonzalez.

The big picture: The Center for Reproductive Rights filed a complaint on behalf of five women challenging Texas' trigger ban and six-week bans, and is asking a state court to declare that physicians have the authority to provide abortion care when they consider it medically necessary.

• The lawsuit states that each of the five women were denied "necessary and potentially life-saving obstetrical care" despite the risks their pregnancies presented on their lives or their fetuses' lives.
• All five said they had wanted to keep their pregnancies, but the complications made that impossible.
• The lawsuit is not seeking to overturn Texas' abortion bans, but instead get clarification on when a medically necessary abortion can be provided.

Of note: It's believed to be the first legal action brought by individuals who have been denied abortions since the Supreme Court overturned Roe v. Wade.

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