Senior Citizens May Soon Find Healthcare in their Pharmacy or Grocery

August 24, 2006 – It is estimated that retail clinics – medical clinics that treat common ailments at a lower cost, in a convenient location and without the long wait for service – will grow from about 150 today to as many as 10,000 in just a few years. Senior citizens will soon find them in their neighborhood pharmacy or grocery store, or beneath a neon sign on the corner. There has been a flood of news coverage on this mushrooming phenomenon, since CVS Pharmacy purchased the industry leader, MinuteClinic.

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A USA Today article says the clinics "are spreading nationwide as more than a dozen clinic operators plan to open thousands in stores such as CVS, Wal-Mart, Walgreens and Kerr Drug." They are also popping up on Texas grocery stores.

Reporter Julie Schmit says, " They treat common ailments only — such as strep throat, ear infections and allergies — and offer an alternative to packed doctors' offices and pricey emergency rooms.

"Some doctors warn that patients won't get top-notch care at the clinics. Others say they fill a need, especially on nights and weekends, when doctors' offices are closed.

"While the clinics vary by company, most treat 25 to 40 medical conditions and charge $45 to $75 a visit."

Nurse practitioners are usually on the on-site staff for these clinics but increasingly they are associating with hospitals of doctor groups.

The USA Today article says, "HealthPartners, a Minnesota-based health maintenance organization, analyzed two years of MinuteClinic claims data and found total costs about 25% less for MinuteClinic treatments compared with those done at doctors' offices or urgent-care clinics."

Prescription costs were $3 higher for MinuteClinic clients, HealthPartners told the newspaper. That may result from higher prices at store pharmacies, more prescriptions or less use of generic drugs, according to HealthPartners.

The other major retail clinic operators, besides MinuteClinic, are Take Care and RediClinic.

Texas Medical Association Action

In January, the Texas Medical Association, the largest state medical society in the nation representing more than 40,000 physicians, said it fears that quality health care may take a back seat to convenience as the number of InterFit's RediClinics in the Lone Star state continues to increase, according to a report in the Houston Business Journal.

In Houston, the Memorial Hermann Hospital System is providing physician oversight for the clinics, which are located inside retail outlets and are open seven days a week. InterFit operates RediClinics in Wal-Mart Supercenters in Arkansas and Oklahoma, and in H-E-B stores in Texas. At least five clinics are located in the Houston area, the first of which opened last June, according to the HBJ report.

The Blogs Chime In, Too

Fierce Healthcare Blog

Now traditional medical providers are taking notice of retail health clinics and even throwing their hats in the ring in order to protect themselves from competition, says the blog Fiercehealthcare.com.

Some health systems have staffed their own clinics, signed contracts to oversee clinic staff or set up referral systems with the in-store clinics. By partnering rather than competing with the clinics, physicians can enjoy a slice of the profits while at the same time easing critics' concerns about quality-of-care issues.

Traditional health providers have recognized that the clinics' straightforward and less expensive approach to healthcare could revolutionize how many people, particularly the uninsured, receive medical treatment.

In addition, the growing popularity of the consumer-driven health plan (CDHP) means that more people are looking for ways to cut down on their out-of-pocket medical expenses. With an estimated 10,000 sites to open by 2010, it looks as though doctors had better learn to play nicely with the clinics.

>> Read the Fierce Healthcare Blog report - click

Hospital Impact Blog

Local newspapers are reporting that the deal (VCS purchase of MinuteClinic) went for $170MM - that's about $2MM per site. Keep in mind that this is for a unprofitable $20MM business. Some MBA exec in CVS Corporate is obviously seeing some compelling positive economics to make such a big investment. They are adding 200 more sites this year, and then few hundred more per year after that.

Also, $77MM in VC funding just went into Take Care Health Systems, the biggest competitor of MinuteClinic. They plan to open 200 locations in the next year and 1,400 more by the end of 2008.

So, in 3 years time, just with these two biggest players, we can expect to see 2,000-2,500 of these - 1 for every two or three hospitals. And we're just getting started, right? If Walgreen's and CVS both jump abroad, that's another ~10,000 potential sites to be considered. Add also grocery stores, malls, or any other retail setting (banks? new tagline: live long and prosper?).

>>Read the Hospital Impact blog report - click

Last year, the Harris County Medical Society board on socioeconomics met with H-E-B officials and sent the San Antonio-based grocery chain a letter expressing numerous concerns about the clinics, charging that they are limited in the services they can provide.

TMA boardmember Dr. Michael Speer told the HBJ that "RediClinics may be acceptable when patients are seeking flu shots or simple procedures such as checking blood pressure. But for more serious matters, the TMA believes patients need to see their regular doctors."

Although some doctors warn that patients won't get top-notch care at the clinics. Others say they fill a need, especially on nights and weekends, when doctors' offices are closed, according to USA Today.

Most clinics do or will take insurance, are walk-in and are open evenings and weekends, USA Today says. They advertise short waits and 15-minute exams, and some give out pagers so clients can shop while waiting. Prices are posted - at MinuteClinic, on an electronic sign, as in a fast-food restaurant.

American Academy of Family Physicians Sets Desired Attributes

"The growth of retail health clinics was spurred by several factors, including a trend toward consumerism in health care and health insurance plans that shift more responsibility and cost to the worker in plans that often waive copayments for services delivered in retail health clinics," according to the American Academy of Family Physicians.

Throughout 2005, the AAFP worked with companies such as MinuteClinic and Take Care to develop desired guidelines.

Retail health clinics should offer a well-defined and limited scope of services, referrals to physician practices when patients' symptoms exceed the clinics' scope of work and an operating philosophy that encourages medical homes for patients, says the AAFP Board of Directors.

The AAFP says the desired attributes in these retail clinics are

● a well-defined and limited scope of clinical services;
● clinical services and treatment plans that are evidence-based and quality improvement-oriented;
● formal connections with physician practices in the community, preferably with family medicine practices, to provide continuity of care. Other health professionals should operate only in accordance with state and local regulations and should be part of a care team operating under physician supervision;
● codified systems for referring patients to physicians when patients' symptoms exceed the clinics' scope of services;
● use of electronic health record systems -- preferably, systems that are compatible with the continuity-of-care record supported by the AAFP -- that can communicate patients' information with the family physicians' offices.
The list will help chapters and members determine whether to work collaboratively with retail health clinics that locate in their areas, according to an intra-organizational memo from AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif.

"We hope that the list of desired attributes will be a good starting place for discussion and negotiations at the local level," said Frank in the memo. "Rather than expending energy in an ultimately unsuccessful attempt to 'stop' the retail clinic model, the goal at the national and chapter level should be to provide accurate information, to promote family medicine as the 'medical home,' and to try to ensure that clinics operate according to AAFP's desired attributes."

It is key, Frank said, for all such clinics to encourage patients to have a "medical home."

Links:

>> Read the USA Today report – click here

>> Read the American Academy of Family Physicians report – click here.

>> Read the Houston Business Journal report - click

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