By Miranda Crowell
It’s not groundbreaking news that retailers such as Walgreens, CVS Health, and Walmart offer medical care to consumers “on the go.” But in the words of Emeril Lagasse, some of the retail clinic providers have really “kicked it up a notch.” From an expanded scope of services to a heavy use of technology, retail clinic providers continue to shake up and successfully compete in the healthcare market.
Here are just a few examples:
CVS Health removed all tobacco products from its shelves in September 2014, a month ahead of schedule, added the word “Health” to its corporate name, and racked up over 900 locations of Minute Clinic across 31 states and the District of Columbia. CVS Health’s website touts that the Minute Clinics have clocked over 24 million patient visits with a 95% satisfaction rating. Even more interesting is the fact that CVS/Minute Clinic has received accreditations from the The Joint Commission (the national evaluation and certifying agency for health-care organizations and programs in the United States) on more than one occasion.
Walgreens has formed partnerships with WebMD to give Walgreens customers access to “virtual wellness-coaching programs.” Furthermore, Walgreens uses the Balance Rewards program to reward their customers for exercising, for tracking their blood glucose levels, and for accomplishing fitness goals. For instance, a customer can get 20 points for jogging a mile. The Walgreens Healthcare Clinics are integrated into Walgreens stores, and a customer can schedule an appointment online. I downloaded the Walgreens app and checked out a few of the clinic’s features online. Some of the features I found most impressive were the complete cash price list for customers who will not be using insurance for their visit and the ability to securely chat with a member of a pharmacy team through the app. Additionally, scheduling an appointment was a breeze on the company’s app, and I could easily see if Walgreens accepted my insurance on their website.
Walmart has taken their services a step further. While most retail clinic providers offer medical care for non-urgent matters such as sore throats, physicals, and basic testing for things like blood glucose and strep throat, Walmart claims to be different. And to prove it, Walmart states that its “expanded scope of services enables [it] to be [the customer’s] primary medical provider.” (emphasis added).
For purposes of this discussion, if one defines the healthcare consumer as a person in need of basic medical care, then the benefits of choosing a retail clinic over other medical providers are clear: scheduling convenience (including convenient locations, extended hours, and online scheduling tools), price transparency, and timeliness. In 2014, The Advisory Board Company asked almost 4,000 consumers what they preferred in a health care clinic treating low acuity illnesses like sore throats. With little surprise, convenience holds the key: walking into a clinic without an appointment and being seen within half an hour was ranked first out of 56 variables. Traditional primary care delivery models are not ignoring the shift either. For example, Novant Health has partnered with Target in select locations to open walk-in clinics, and Temple University Health Systems operates ReadyCare clinics in Philadelphia. But what happens when what the customer thinks is a simple sore throat turns out to be something more troublesome?
While transparency through websites, apps, press releases, etc., of retail clinics is seemingly high, one area is lacking: information on patient referrals. Retail clinics are positioned to refer patients should their case become complex, but with many retail clinics offering chronic disease management, some cases that would usually be involved in referral process can be kept within the clinic doors. As Ronald L. Hammerle, President of Health Resources, stated, “The sophisticated player recognizes that whoever controls point of entry [to health services] manages the downstream revenue.” In other words, clinics with broad services, such as chronic disease management, can grow their business (leading to increased revenue) and partner with surrounding hospitals and doctor’s groups to gain new customers. But if a referral is needed, it is unclear from the retail clinics’ websites and apps how the referral will take place. Walmart’s website at least acknowledges that they can and “will be glad to” refer out a patient should the need arise. So, I took to the street to find out.
Stopping by a Chicago location of a Walgreens Healthcare Clinic, I asked the nurse practitioner how she refers patients to other doctors and specialists should the need arise. A little hesitant, she referred me with a smile to their national patient support center. (I also tweeted Walgreens the questions; I was referred to the same number). While listening to the automated voice serving to filter my call, I was informed that Walgreens Healthcare Clinics can send a summary of the visit to the patient’s primary doctor, although it does not specify how this sharing will occur. Once speaking with a representative, I was told the referral process all depends on the nurse practitioner on duty at a particular clinic and on the patient’s specific needs. In short, it is up to the nurse practitioner’s discretion as to how a patient referral is made.
The referral process from healthcare clinics to primary care doctors or specialists raises some eyebrows. On a previous Fibroblast Blog post, I posited that there are ways to mitigate medical malpractice in the patient referral process. The same concerns apply when the referring clinic is a retailer. Those medical malpractice concerns can be addressed by, inter alia, (1) referring a patient in certain situations, (2) clearly communicating patient education points, (3) securely transmitting patient health information, (4) utilizing a patient referral coordinator, and (5) clearly severing the patient/doctor (or in this instance, nurse practitioner) relationship. But when little is known about the referral process, a nurse practitioner may remain exposed to liability because it is unclear who is actually responsible for the particular patient’s care. Without more specifics on the procedure of a patient referral from a retail health clinic to a traditional doctor’s office, it seems that patient referrals may be the one limitation to retail health clinics. Moving forward, communication of a clear referral process could assist the patient in making an educated decision as to whether or not they should visit a particular health clinic. But in the present, your next health visit could be just a few clicks away.