Healthcare goes retail: In-and-out check-ups
It's Saturday morning, and you're off to take care of the weekly errands: Dry cleaners, grocery store, and a quick stop at the drugstore. Your son has been complaining of a sore throat. At the drugstore, he can see a medical provider, get tested for strep, and, if needed, get an antibiotic. Multitasking has never been the same since retail healthcare hit the scene.
When it comes to routine healthcare, many healthcare consumers want more convenient, faster, and more affordable care. The market has responded. Currently, between the three main U.S. retail healthcare providers—MinuteClinic, RediClinic, and Take Care Health Systems—there are more than 100 retail clinics in metropolitan areas across the country. The expansion plans of these three companies are aggressive: Hundreds of additional clinics are scheduled to open in national chains such as Walgreens, Wal-Mart, and CVS by the end of this calendar year.
What's intriguing to watch is not only how popular these clinics are becoming, but how traditional healthcare providers might respond to the trend. Through their focus on convenience, affordability, and the use of cutting-edge technology, retail healthcare clinics might eventually motivate primary care providers to pay closer attention to improving customer service and efficiencies.
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Retail clinics redefine primary care
Although the retail healthcare clinics differ slightly in the services they offer, their business models have become fairly standard since the first clinic opened in 2000 in Minneapolis, Minn. Usually, retail healthcare clinics are:
| • | Located in a retail setting, such as a drug store, grocery store, or discount chain with a pharmacy. |
| • | Staffed by nurse practitioners. |
| • | First-come, first-serve; waits typically no longer than 15 minutes. |
| • | Focused on a narrow range of services covering common illnesses, including colds, ear infections, flu, allergies, minor skin conditions, and preventive care such as vaccines. |
| • | Low cost: Usually $40–$60 US for most services, and rarely above $100 US |
| • | Collaborative with local physicians for case review. |
| • | Visited by customers, including individuals and families with insurance and a primary care physician, and those with neither. |
Good locations, convenience, and lower costs
Retail healthcare clinics are changing how healthcare providers view patients. The clinics see patients as consumers who have choices and deserve great service at a competitive price. The patient as a consumer is a novel idea, yet it's not a perfect fit for healthcare, to be sure. Healthcare providers treat medical conditions for unique individuals—they don't serve up hamburger and fries. The balance that retail healthcare clinics are trying to strike is one that makes good sense for the basic services these clinics offer.
In addition to the convenience of being in a retail setting, the price transparency of retail healthcare clinics is a big hit with patients, according to Web Golinkin, president and CEO of InterFit. Knowing exactly what you must pay for a visit gives some control back to the healthcare consumer. Price transparency for healthcare services will become increasingly important if, as predicted, more and more people move to so-called health savings accounts. With these accounts, healthcare consumers face much higher deductibles before their insurance coverages kick in.
Because the clinics provide only a limited scope of services through nurse practitioners (versus more expensive physicians), costs and overhead can be kept low. All three of the major retail healthcare providers are rapidly expanding, indicating the sector's financial health and investor support.
The clamor over quality
Retail healthcare's aggressive growth plans have raised questions in the healthcare community about the capability of these clinics to maintain patient safety and quality of care. Well-trained, licensed nurses are more than capable of administering care for common ailments such as bronchitis and bladder infections, which entail fairly standard treatment. Retail healthcare providers also maintain agreements with local physicians who review cases and answer any questions nurses might have.
If a patient comes in with a condition that falls beyond the scope of services, the clinic can refer the individual to a local doctor or an emergency room. Retail healthcare clinics also send notes to the patient's primary care doctor after the visit. For patients who don't have a doctor, MinuteClinic encourages them to seek the ongoing care of a physician.
MinuteClinic also adheres to national critical practice guidelines (the Institute for Clinical Systems Improvement, American Association of Pediatrics, and American Association of Family Physicians), which are integrated into its homegrown electronic medical records (EMR) system for clinical decision support. The EMR, which generates patient education materials and builds diagnostic records for primary care providers, was developed in 2003, on Microsoft .NET technology.
Leading the way in information technology
Technology is an important underpinning of retail healthcare. With small staffs and low overhead, it is more viable to implement advanced electronic registration and billing systems, EMR systems, and expert systems for clinical decision support at the point of care. These technologies can help retail healthcare clinics deliver high-quality healthcare while operating as efficiently as possible. Retail healthcare's tight integration of technology with clinical practice is another point of differentiation with primary-care practices—which are still largely practicing medicine on paper.
RediClinic also developed its own clinical protocol-based EMR and practice management system. RediClinic and Woodburn agree, there are no appropriate off-the-shelf packages yet, according to Web Golinkin, president and CEO of InterFit. Nurses log on to the Microsoft SQL Server and Web-based system during the patient visit to collect medical histories and symptoms, write prescriptions, and check for drug interactions. The EMR guides the caregiver down one of two clinical protocol paths: A stay well visit or a get well visit (the former is for health screenings and preventive care; the latter is for all other visits).
The system automatically generates a printed receipt and summary of the visit, which the patient can bring to her primary care doctor. Collaborating physicians can review patient files online through a security-enhanced extranet. And patients can log on to the site to view online results of stay well screenings and even fax those results to their doctor from the site. "Integrating with the current healthcare delivery system is really important," Golinkin says.
The end goal, according to George Walker, IT manager with InterFit, is to store a patient's full record online, so that patients can better manage and track their own healthcare. Walker says that RediClinic will integrate more protocol-based decision support into its system and is looking into patient kiosks.
Overcoming resistance
There are many potential benefits of the retail healthcare movement, but not everyone in healthcare is wild about the idea. Retail healthcare providers position their services as an adjunct to the primary care physician, rather than as a replacement. Yet there is concern that retail healthcare clinics will take profitable business away from primary care practices.
On the other hand, retail healthcare clinics are changing the dynamics of how healthcare is delivered. Should this trend take off in a big way, primary care providers can focus more on complex and chronic conditions and long-term preventive care.
Woodburn says that there's less uncertainty and anger than a year ago now that physicians have a better understanding of what retail healthcare clinics are trying to do. "The tide is really shifting toward acceptance," Woodburn says.
And with this shift toward acceptance is a likely shift in attitude down the road. Traditional doctor's offices will need to adapt by having: A real marketing and customer service mindset, better information technology for improved accuracy and outcomes, extended hours, and price transparency. The latter will likely result in lower charges for certain services. In essence, family practices will need to fight for their patients.
Like it or not, retail healthcare is probably here to stay. The clinics should not replace the primary care doctor, but their impact on primary care could be large.
 | Dr. Bill Crounse, M.D.
Dr. Bill Crounse, M.D., is senior director, worldwide health for Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. Also, read Dr. Crounse's Healthcare Web log to get more insights into the latest technologies and trends in the healthcare industry. |
