At almost the opposite end of the spectrum from Concierge Medicine lies what I call "Convenience Medicine" and is elsewhere called "retail health" - a business model offering highly accessible clinics in retail locations with high foot traffic. These may be located in relatively affluent areas, or increasingly, in areas where large  numbers of under- or uninsured people shop.

Some examples of companies providing these accessible services include California's QuickHealth, nationwide MinuteClinic, Oregon's ZoomCare, and Arizona's MediMin.

Equally entrepreneurial, the providers of this kind of care appear to be betting that well-priced, walk-in care for a set of routine services is just what healthcare consumers, and their insurers, are willing to pay for.

This is a typical list of conditions treated in these clinics (taken from Zoomcare's home page - their top ten conditions treated in December):

• Sinus Infections
• Throat Infections
• Bronchitis
• Bladder Infections
• Ear infections
• Skin Infections
• Eye Infections
• Injuries
• Cuts
• Flu

Other services include STD testing, school physicals, immunizations, pregnancy testing, and minor procedures such as wart removal and suturing uncomplicated wounds.

At the heart of this business model is the idea of "consumer-driven primary care delivery focused on the needs of the uninsured and underinsured, as well as the insured population that is looking for more convenient and cost-effective primary care" (taken from the QuickHealth company profile). 

Some of the ways in which this model is consumer-driven might be:

• pricing transparency - prices are stated up front, on websites and menu boards near the entrance
• healthcare service "packages" with bundled pricing - creatively named HealthyHeart and HealthyLover (QuickHealth)
• same-day service
• walk-in service, with a commitment to short waiting times
• self-scheduled appointments via the web (ZoomCare)
• convenient pharmacy services - ZoomCare has its own pharmacy, ZoomStore, while the MinuteClinics are located within or adjacent to pharmacies

Unlike the services of concierge practices which have generally not been covered by insurance companies, those of these convenience clinics have - and savings can be substantial. According to the AAFP, a typical retail health clinic visit averages $49, versus a physician's office visit of between $85 and $110 for the same condition.

So just how are these clinics able to provide services at these rates?

It appears that there are several factors in play here:

• the ability to take advantage of technology, such as touch screens to check in, evidence-based decision support software, and electronic medical records that can be reviewed at a distance (in situations where the care is provided by nurse practitioners or physicians' assistants).
• lower overall cost structure, primarily due to location in cheaper rental space, limited number of conditions treated, and use of physician extenders such as NPs and PAs.
• other ways to lower overhead such as reduced laundry (no patient gowns to launder), limited rapid testing with CLIA wavers, minimal furnishings, and easily managed payment systems, such as the ability to collect cash or charge a credit card at the time of service, or use electronic claims management systems where insurance is accepted.

Read this comprehensive report by Mark D. SMith MD MBA, President and CEO of the California HealthCare Foundation to find out more about this intriguing model of care.

My questions to you are -

1. What can you take away from this model to stimulate your thinking about your practice?
2. How are you going to compete to provide valuable services to patients who might otherwise "defect"?
3. How can you "capture more market share" by attracting new patients that might have dropped in to that neighborhood retail clinic?