Tapping into the trend for providing "convenience" medicine

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?

Update on Tuesday, May 15, 2007 at 01:09PM by Philippa Kennealy

Here is a thoughtful collection of comments from the Health Affairs blog about convenience clinics - what do you think the newest name for them - McClinics?

Comments

[Dr. F]

Yes, I agree innovation in the retail arena will continue. The biggest problem is trying to change the inherent weaknesses of retail medicine to make the model more appealing.
The first model in convenience medicine was minute clinic, but it should look over its shoulder soon to see a better model coming.

MeD thru Medicine

[Gary Levin MD]

Excellent review and suggestions. Not only is this a disruptive change, but also a "catalytic innovation."
Check out my latest on healthtrain express (see url above).

This may be a good thing, but as you know there can be many pitfalls if not managed properly for QA...If they are a modified urgent care center, they will need a network of supporting MDs.....that may be a problem for them except in physician oversupplied areas.

[Greg Marmes]

Does anyone know how these retail clinics are able to take patient money without being entirely owned by physicians? Are they fee-splitting?

thanks

[Philippa Kennealy]

Greg

In some states, there is no "Corporate Practice of Medicine" which means that non-physicians can own physician businesses.

One model for California (which does bar the corporate practice of medicine) that I have a little familiarity with, is one in which the physicians who oversee the protocol development, and nurse practitioners' records etc, actually form their own businesses. They then serve as independent contractors to the retail clinic company owner, contracting to perform certain duties for an agreed-upon fee. They get a Medical Director fee and an hourly consulting fee and then some type of ownership in the retail clinic company.

I hope that answers your question!