Milk, Bread ... and a Doctor Visit
A dozen years ago, the first retail health clinic — a QuickMedx, later MinuteClinic — opened at a Cub Foods store in Minneapolis-St. Paul. Treatment was available for seven specific conditions: strep throat, mononucleosis, flu, female bladder infections, ear infections, sinus infections and pregnancy testing. Patients paid cash, and then went on their way.
Since then, however, a shortage of primary care physicians, rising concerns about access and costs, looming health reform requiring expanded coverage and care coordination and the ever-older Baby Boomer population have combined to create a unique prescription for success.
Though growth of the clinics slowed in 2009 and 2010, 2011 showed a marked shift: The number of in-store clinics (1,355) rose 11.2 percent, according to research and consulting firm Merchant Medicine.
“We know a lot more than we did when we first started,” says Merchant Medicine CEO Tom Charland, a key player since the field’s early days. “When we started this industry ... we were proposing not just to consumers, but also to traditional healthcare providers, the idea of getting healthcare in the grocery store. And that notion, to many people, was unusual.”
Today, traditional healthcare providers are much more likely to see clinics as partners rather than competition. And retailers are seeing benefits at on-site pharmacies and in related over-the-counter sales.
I n addition to MinuteClinic, a subsidiary of CVS Caremark with more than 500 locations nationwide, the largest operators of health care clinics include independently owned RediClinic, The Little Clinic in Kroger stores, Take Care Clinics at Walgreens and NowClinic at Rite Aid.
Each offers convenience through hours longer than traditional doctors’ offices, low costs, access to an on-site pharmacy and care for common ailments, typically by a nurse practitioner. Treatment is meant to supplement that of a primary care provider, and the clinics often are aligned with area doctors’ offices, hospitals or healthcare systems for oversight.
But as acceptance has grown and clinics and affiliated retail outlets look for new avenues of service and revenue, attempts at differentiation abound.
Consider RediClinic, found in 29 H.E.B. grocery stores in Houston, Austin and San Antonio, Texas. The on-site clinics help H.E.B., the largest grocer and private employer in Texas, control employee healthcare costs and increase productivity, says RediClinic CEO Webster Golinkin.
Last year RediClinic introduced Weigh Forward. Billed as the first comprehensive, medically supervised weight management program delivered in a grocery store, it was designed by Dr. David Katz of the Yale School of Medicine.
“It’s a logical extension,” Golinkin says. “From the beginning, we’ve focused on providing preventative care in addition to acute episodic care. We treat the same routine conditions as other retail-based clinics, but we also offer a broad menu of screenings, tests, immunizations and physical exams.”
Since launching in May, he says, the 10-week program has met with an “extremely positive response,” partly because it includes weekly meal plans and recipes with a shopping list of items available at the store. “That element of convenience is impossible for other weight management programs to duplicate,” Golinkin says, “and the fact that our program is delivered by in-store healthcare professionals also sets us apart.” As of February, more than 500 people had signed up.
RediClinic’s mission “is to provide easier access to high-quality, affordable healthcare, and that’s what we’re doing,” says Golinkin, who is also president of the nonprofit Convenient Care Association. “The company has grown, and the clinics have grown in number and in utilization, mainly because patients like the experience.
“We’re located in a retail outlet where you can do other things,” he says. “We’re open seven days a week, including extended weekday hours, and you don’t need an appointment. Visits last about 15 minutes ... so if there’s a line at least it’s a predictable one, and you can shop the store while you wait. And if we write you a prescription, you can get it filled in the in-store pharmacy.”
Approximately 80 percent of RediClinic prescriptions are filled at H.E.B. in-store pharmacies.
P atients at a number of Rite Aid pharmacies in Michigan and Pennsylvania are having a slightly different experience. In September 2011, Rite Aid announced it was collaborating with information and technology-enabled health services provider OptumHealth to introduce NowClinic online care. At these pharmacies, patients can have private, face-to-face consultations with doctors via the Internet.
Electronic records of the visit can be printed and/or exported to the patient’s primary physician for continuity of care. OptumHealth has a similar service that patients can access from home, 24 hours a day, in 22 states; workplace kiosks are under consideration.
“There’s always a theoretical barrier to the early adoption of ideas,” says Dr. James Springrose, NowClinic’s medical director. “But we’re seeing an upswing of utilization in both the Rite Aid and home environments. It’s actually been faster than we thought .... People are indicating a real interest in using new technology to seek healthcare.”
As for the Rite Aid stores, changes in messaging are underway and signage and branding have increased to draw the consumer’s eye.
“I’ve been personally involved in seeking input from medical communities across the country and talked with dozens of medical societies, and the input has been positive,” Springrose says. “They’re cautiously supportive. They realize instinctively that this is the way medical care is heading.
“Physicians realize that at some point they may be offering telehealth to their own patients as part of extending access to their practices,” he says. “We believe that better access to care ultimately serves the patients’ interests.”
Patients, partnerships and promise
I n Atlanta, MinuteClinic recently collaborated with Emory Healthcare, the state of Georgia’s largest and most comprehensive hospital system. Such an alignment is far from new: MinuteClinic has formal affiliations with 15 of the nation’s leading health systems; Walgreens collaborates with Ochsner Health System in New Orleans, among others; and RediClinic collaborates with the top healthcare systems in each of its Texas markets.
Dr. F. Kennard Hood, a family physician with Emory Specialty Associates, serves as a medical director in the MinuteClinic system. He’s come to see the relationship between traditional healthcare providers and retail clinics as truly synergistic, and expects it to be even more so when electronic records are more frequently shared.
“We can benefit each other,” Hood says. “There are things that they don’t do that we can, and vice versa .... And the clinics are good about telling patients that they need a medical home, a primary care physician that they can depend on [and see] on a regular basis.”
Retailer benefits can be both tangible and intangible. At Walgreens, the 350 Take Care Clinics are a key component of a broader initiative to transform the retailer from a traditional drug store to a health and daily living store. Heather Helle, division vice president, consumer solutions group for Take Care Health Systems, says new formats include rooms for community education. Pharmacists are moving out from behind their counters to better interact with customers. In addition, there’s a greater level of transparency and access; visitors to the Take Care website can easily find reviews and patient satisfaction scores.
“In the beginning, patients just saw us as ... a place to get the flu shot,” Helle says. But as awareness has grown, “consumers have begun to look at us as the place they can meet a broader array of healthcare needs.”
An estimated 50 percent of patients coming through the clinic doors have no primary care provider. Take Care responds with extra touches like the ability to book appointments and check wait times online, and every patient (other than those simply receiving shots) gets a follow-up call within 48 hours. As a result, Take Care Clinics boast satisfaction scores in the top 10 percent of Gallup satisfaction surveys — which includes organizations like Ritz-Carlton.
MinuteClinic also enjoys high ratings – 94 percent — on the overall patient satisfaction front. Dr. Andrew Sussman, MinuteClinic president and senior vice president/associate chief medical officer for CVS Caremark, notes that MinuteClinic has a Net Promoter score of 80 percent, “on par with some of the best-known brands like Apple Computer and Amazon.com.”
As the largest retail clinic provider, MinuteClinic is present in 25 states and the District of Columbia, and has seen more than 11 million patients since its inception — more than 10 million of them in the last five years (CVS acquired MinuteClinic in fall 2006). Seeing such growth as a springboard, 400 more clinics are planned for the next four years.
If today’s time-starved, increasingly-used-to-individualized-service consumer has anything to say about it, the clinics won’t be going anywhere any time soon.
“We used to get medical care on the medical provider’s terms,” Charland says. “Most people credit the concept of retail health with putting medical care back into the consumer’s hands.”