Is there a consumer-driven market business trend offering a cost-effective and highly convenient means of receiving care for basic and routine conditions? Retail health clinics such as those found in CVS or Walmart might be the answer. The appeal of such clinics is increased access to care (generally open from 10-12 hours/day, on weekends). This set-up is ideal for busy working people and the care received complements that given by the patient’s primary care doctor. Furthermore, the total charges billed to the patient are shared up front. The patient demographics are pretty similar to those in those elsewhere, with 80 percent insured and 20 percent uninsured. Retail clinics will only treat minor problems and perform preventative care (immunizations, etc.) –the rest must be referred out.

A SWOT analysis provides a framework by looking at the advantages, disadvantages and opportunities for improvement regarding a particular business venture. As relates to retail health clinics, the SWOT results are below.

Strength:

• Reduces barriers to access to service (increased wait times in ER, doctor’s office)

• Cost transparency facilitates patient decision-making

Weakness:

• Not part of the local health care system and provider network, thereby, more difficult to track data for quality of care studies. Although this is the current state of affairs, it certainly leads to an opportunity of being part of an Accountable Care Organization going forward.

• Interrupts continuum of care established with primary care physician

Opportunities:

• Potential to improve low-income patients’ access to basic preventive and low-level acute services.

• Staffed primarily by nurse practitioners. This is important with the current shortage of primary care physicians, and even fewer physicians going into primary care, resulting in a shortage of as many as 44,000 physicians in the fields of general internal medicine and family medicine by the year 2025

Threats:

• In June 2007, the American Medical Association (AMA) asked state and federal officials for an official probe of retail health clinics. The AMA cited, among other objections, the potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains, since retail health clinic employees could write prescriptions to help pharmaceutical sales.

• May erode a patient’s “medical home” by fostering a dependence on the clinic rather than an ongoing relationship with one primary care physician.

Closing Comments

With health care reform, many of these clinics may not get patients since health coverage could become universal. However, on the other hand, many could be forced to enlist into high-deductible plans and so end up coming to these clinics which would make more sense (since costs are transparent to the patient).

In a healthcare system that is as complicated as the one here in the United States, there are always new ideas generated on how to optimize delivery of services. No one form of healthcare delivery is ideal but the important thing is to be adaptable to changes in the environment. Retail clinics, whether they are the new successful consumer-driven market trend or not, definitely have made their mark in American healthcare.

By Jitesh Chawla, MD

CMIO, Patagonia Health