RETAIL BASED CLINICS

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RETAIL BASED CLINICS

• Deborah Callanan
• Spring 2007

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Moi-care-individual wants care which conforms
to his needs, objectives and schedule

• Youre Sick, Were Quick
• Get Well-Stay Well-Fast
• Great Care-Fast and Fair

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History

• First opened 2000 in Minneapolis-St. Paul
• Treatment for 11 common conditions
• 35 per visit
• Did not take insurance
• In mid 2006, 12 operators with 90 clinics
• Wal-Mart --clinics in 1.5 of stores in 2006-7,
  works with 11 different providers

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Difference from Urgent Care

• Limited Service
• Co-location with pharmacy (pharmacies, groceries,
  big box)
• Lower cost structure
• Usually staffed by nurse practitioners
• Software with evidence based guidelines
• 200-500 square feet

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• Currently 40 accept insurance
• Some insurers eliminate co-pays
• Some insurers negotiate for rapid payment with
  random audits

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• High fixed costs (85)
• Need more than 30 visits per day to break even
• Rent often discounted because stores hope to
  generate increased pharmacy and store sales
• Retailers may use RBCs for employee care

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• Disruptive innovation
• Cheaper, simpler, good enough

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Appeal

• CDHPs--lower cost
• Uninsured
• Convenience
• Mexican immigrants

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• Most states require licensure as physician
  practice
• Some health care systems are adding these to
  their scope of practice
• CVS purchased MinuteClinic in July 2006

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Harris Poll

• 7 had used RBC in 2005, 5 in 2007
• 59 who had not used service would be unlikely to
  use it in 2005
• Of users in 2005, 92 satisfied with convenience
  (83 in 2007), 89 with quality and 80 with cost

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AAFP Guidelines

• Defined, limited scope of service
• Use evidence based medicine
• Team-based approach
• Referral system
• Electronic health records
• AMA Also inform patients of provider
  qualifications
• AMA views RBCs as part of free market competition

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AAP Recommendations

• Support the medical home
• Communicate with PCP
• Use evidence based medicine
• Use care to prevent spread of contagious diseases
  in retail environment
• Eliminate financial incentives for care at RBCs

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Problems with Organized Medicine Opposition

• Availability of off hours care
• Ability to schedule urgent appointment

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Appeal Not Universal

• Take Care closed clinics in Portland, OR after
  less than a year in Rite Aid
• No medical care access problem
• Kansas City clinics a success

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CCA Standards

• Thorough credentialing
• Quality monitoring
• Relationships with traditional HCPs
• Encourage patients relationship with PCP
• Compliance with OSHA, HIPAA, etc.
• Health promotion education
• EHRs
• Suitable environment
• Relationship with emergency services
• Empower patients to make informed choices

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Business Challenges

• Demand management
• Evaluate demographics
• Balance with host pressures
• Evaluate repeat business
• Manage service quality
• Link staff with other providers
• Manage public health issues

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Future

• Will the public want rapid service with no
  provider relationship?
• Will more health care organizations participate
  in these ventures?
• Will retail outlets feel they earn enough money
  from these ventures?