Retail Clinics

1
Retail Clinics

• Presentation to TAHP Annual Meeting October 17,
  2007

2
Outline

• How Did We Get Here?
• Retail Clinic Business Model
• Players
• Driving Forces
• Consumer Appeal
• Potential Issues
• Where to Next?
• Policy Issues

3
How Did We Get Here?
4
Barber/Doctor
5
Traditional Family Doctor
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Steps Along the Way

• Healthcare of Future Project
• GMENAC Study of mid 1980s
• Urgent Care Centers
• Physician Offices in Shopping Malls
• Fast Track Emergency Department
• Call Center Triage Software

7
Hospital Emergency Departments

• Emergency Departments
• Still the New Family Doctor
• Average Waiting Time 240 minutes (2006)
• Texas 249 minutes in 2006
• Waiting Time Up from 186 minutes in 2003
• 12 Hours in Flu Season
• National Examples of Waits in Excess of 18 Hours

8
Hospital Emergency Departments

• Hospital EDs
• 13.9 of Visits in 2005 Were for Non- Urgent
  Matters Such as Bladder Infections and Fevers
• Well, Worried Well, Near Sick and Sick

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Driving Forces

• Convenience Focused Society
• Time Off Work Issues
• Single Parent Families
• Economics

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Tired of Waiting for a Doctor? Try the Drugstore
or Grocery Store!
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Which Would You Pick?

• Wait 4-5 Hours in the ED and Pay 300
• OR
• Go to the Retail Clinic, Wait 20 minutes and Pay
  50?

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Retail Clinic---What is It?

• Rental Space in Retail Store
• 80-400 square feet
• Mid Level Practitioner
• Nurse Practitioner
• Posted Retail Price List
• Convenient Hours
• 8A-7P M-F/9-5 Sat/10-5 Sun
• Fast Service
• 15-25 minute wait

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Typical Patient

• Sore Throat
• Ear Ache
• Sinus Infection
• Bronchitis/Cough
• Fever
• Bladder Infection

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Business Model

• Replace Loss of Walk- In Store Volume
• Mail Order Pharmacies
• Drive New Customers to Retail Chains
• Impulse Retail Buys
• Defensive Strategy with Competitors
• Business Model is to Bring More Walk-Ins to the
  Store
• Retailers Gain From Rent

15
Players

• MinuteClinic
• Physician Founded
• CEO former Arbys Executive
• CVS and Target
• 300 Sites Planned

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MinuteClinic
17
MinuteClinic Locations
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Players

• MinuteClinic
• Physician Founded
• CEO former Arbys Executive
• CVS and Target
• 300 Sites Planned
• Take Care Health Systems
• Travel Agent Founded
• Osco, Rite Aid and Eckerd Drug Stores
• 1,400 Sites Planned

19
Take Care Health Systems
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Players

• RediClinic
• Steve Case, former CEO of AOL
• Duane Reed, H-E-B
• 75 Sites Planned

21
RediClinic Locations
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Players

• The Little Clinic
• Kroger and Publix
• 50 Sites Planned
• Open in Kentucky, Indiana, Florida, Georgia, Ohio
• Wal-Mart
• 400-2000 Sites Planned

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Wal-Mart
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Another Player
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Your Neighborhood?
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Your Neighborhood?
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Your Neighborhood?
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Roll Outs

• Much Slower than Announced
• Approximately 700 Open
• Wal-Mart
• Has Been Debating Healthcare for 10 Years
• Beauty Shop/Barber/Nail Salon/McDonalds/Optical
  Shop
• Why Not Add a Retail Clinic to the Mix

NY Times 8/23/07
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Consolidation

• Business Units Already in Play
• CVS Acquired MinuteClinic 2006
• Walgreens Acquired Take Care 2007
• Next in Line?

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Consumer Appeal

• No Waits
• Quick in and Out
• No Time Lost from Work
• Relief from Medical Problem
• Low Cost
• Possibly No Co-Pay

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Consumer Opinions

• Convenience 92 Satisfied
• Quality 89 Satisfied
• Staff Qualifications 88 Satisfied
• Cost 80 Satisfied

Harris Interactive Poll October 2005 for the Wall
Street Journal
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Access to Primary Care Physicians

• U.S. Getting Further Behind the Curve in Access
  to PCPs

33
Primary Care Physician Shortage

• Hierarchy Issues
• Compensation Factors
• 180,000 for IM, 160,000 for FP versus 250,000
  for Specialists (2005)
• Reduced Residency Slots
• FMGs/Non-US Citizens
• Foreign Medical Schools for US Citizens

34
Primary Care Physician Shortage

• Only 20 of Internal Medicine Residents Choosing
  to be Generalists

2006 NEJM
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Shortage of Primary Care Physicians

• US 1928 open searches
• TX 278 open searches

Shortage Probably Will Get Worse
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Do You Have a PCP?

• In Some Geographical Areas, Up to 50 of
  Population Do Not Have a Primary Care Physician
• Not Taking New Patients
• Practice is Full
• Insurance Network
• Medicaid/Medicare
• Uninsured

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Wait for an Appointment

• Generally Weeks

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Working Families/Single Moms

• Tough to Get Off Work

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Retail Clinics

• Filling a Void
• Meeting a Need
• Filling a Niche
• Convenient

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Advice to Clients

• Develop Owned Primary Care Network
• Include an Alliance with Retail Clinics
• Geographically Dispersed Locations
• Leverage with Mid Level Practitioners

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Primary Care Network Benefits

• For Hospitals/Health Care Organizations
• Base for Referrals
• Improve Access
• Open to low income/uninsured
• Improves Prevention/Early Detection
• Reduces Charity Care Write offs
• Reduces Cost of Care in the Long Term

42
Alliance With Retail Clinics

• Hospitals/Healthcare Organizations Should
• Develop an Alliance With Retail Clinics
• Offer to Provide Medical Direction
• Source of Referrals to Physicians

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Retail Clinic Issues

• Oversight
• Physician vs. Retail Corporation
• Licensing Issues
• Continuity of Care
• Medical Records
• Professional Stimulation
• Retail Pharmacy Patient Steerage
• Staffing

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Performance Standards

• Scope of Service
• Evidence Based Medicine
• Team Based
• Referral Mechanism
• EHR Compatible Records

The American Association of Family Practitioners
and Several of the Larger Retail Clinics have
agreed to support these five initiatives in
Retail Clinics February, 2007
45
Evidence Based Comparison

• Americans receive evidence-based care 55 of the
  time from conventional health-care source
• .
• MinuteClinic's analysis of 58,000 sore-throat
  cases seen at their clinics conformed to
  evidence-based guidelines 99.15 of the time.

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Nurse Practitioners

• Retail Clinics Reliant on NPs
• Patients Give These Professionals High Marks
• Spend More Time
• Seem more Caring
• Highly Trained

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Nursing Shortage

• 118,000 shortfall of RNs 2007
• 55 plan to retire 2011-2020
• Shortages of Nurse Practitioners with Growing
  Demand

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Nurse Practitioners

• Nurse Practitioner Supply 141,000 (2004)
• Retail Clinics May Need 10,000

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Retail Clinics Passing Fad or Here to Stay?

• Retail Clinics
• Most Likely to Be Here in One Form or Another
• But Will They be a Sustainable Financial Model
  for Corporate America?

50
Policy Issues

• US Needs to be More Aggressive in Prevention and
  Early Detection
• Additional Emphasis on Primary Care
• Increase Supply and Access to PCPs
• Leverage PCPs with NPs and PAs
• Increase Nursing Supply

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Policy Issues

• Lifestyle Changes
• Access to Affordable Drugs
• Universal Health Insurance/Coverage
• US Uninsured Increased from 44.8M to 47M (2005)
• 15.8 of US Population Now Uninsured
• 34 of US Households Pay More than 1000/Year in
  Out of Pocket Medical
• 14 in Canada

Uninsured Source US Census Bureau 8/07
Out of Pocket Source Health Affairs 2005
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Maybe Next Year?

• Drive Through Starbucks and Primary Care at the
  Window?

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Retail Clinics
Eben G. Fetters, FACHE Principal 512-371-8008 efet
ters_at_rpcconsulting.com

• Presentation to TAHP Annual Meeting October 17,
  2007