One-third of your patients shop at Walmart every week—and it could become your most formidable competitor.
March 18, 2014 – This retailer is advancing toward the health care market, and while we don’t know how far Walmart will go, they could expand enough to disrupt your primary care referral chains, launch a nationwide health plan, or more.
Retail medicine and price transparency are quite possibly the future of affordable health care in the U.S. Like most large pharmacies, the creators of ‘Retail Medicine’ understood years ago the need for affordable, convenient and price-driven access to healthcare.
“Until retail and concierge medicine came along, we would blindly walk into a doctor’s office or hospital and not know (or in many cases, care) about how much things cost,” says Catherine Sykes, Managing Director of Concierge Medicine Today. “We don’t purchase our homes, our vehicles or other services in this way. It’s time we stop using our health insurance card as a form of credit.”
A lot of modern health care medical centers and physicians across the U.S. are now starting to show their prices to their patients before they sit down for a visit. Dermatology offices and direct primary care clinics are a good example. Until recently, hospitals, primary care and other health care specialties were one of the only segments in the U.S. that rarely listed how much their fees were for their time, services and products.
According to experts, quick-access clinics can be one part of the solution to improving access to basic healthcare. Some insurers and healthcare systems already have retail clinics in mind for more than just minor, acute care visits, according to Tom Charland, chief executive of the research and consulting firm Merchant Medicine, which tracks the retail medicine market. “Insurance companies are now recognizing that pharmacies and retail clinics can do chronic disease management pretty efficiently. We are in the early stages of this area, but the scope is definitely changing,” he said.
Not only do insurers see retail clinics as facilitators of disease management, but also as a stop gap measure for the growing shortage of physicians. “In geographies where there are critical shortages of primary care physicians, some insurance companies are even paying retail clinics to act as a medical home,” Charland continued. “If there is no primary care physician, the insurers would rather have somebody than nobody. And they feel that nurse practitioners in these clinics are fully able to act as patients’ primary care providers.”
Growth Signals Turnaround
Retail clinics first began making news in 2000, but after an initial jump, some closed their doors only a few years later, with some observers calling the model a failure. Since the mid 2000s, however, the industry has rebounded, with more than 1,300 clinics around the country and nearly 12% growth in 2011, according to Charland. Industry leader MinuteClinic opened 19 new clinics just in September.
While CVS Pharmacy’s MinuteClinic and Walgreens’ Take Care Clinic still dominate, Target and Walmart are expanding their clinic presence, and dozens of health systems are opening their own retail-style clinics, such as Geisinger’s Careworks walk-in clinics.
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“Maybe we should be examining why our patients would rather go to a retail clinic that see us (their primary care doctors),” said Dr. Rob Nelson, a direct primary care physician in Cumming, GA, a suburb of Atlanta, GA. “Here are just a few of the comments I hear from PCP [primary care physician] patients as to why they come to the retail care centers instead of their primary care physician: my PCP doctor couldn’t get me in; my PCP doesn’t do stitches anymore; my PCP doesn’t do x-rays in office; my PCP doesn’t take walk-in patients; my PCP usually refers me to specialist for everything anyway; and my won’t return my calls.”
As the healthcare system prepares to cope with an influx of 30 million Americans who will have health coverage as a result of the Affordable Care Act, a surging market of retail clinics is poised to take on a wider role to relieve the bottleneck. According to a recent article by Bill Malone in the AACC, he writes ‘Retail clinics are also adding new tests that go far beyond caring for scraped knees and scratchy throats. The growing list of tests includes lipid panels, HbA1c, microalbumin, HIV, fecal occult blood, influenza A and B, and even screening for methicillin-resistant Staphylococcus aureus. Clinics offer many of these tests as part of adult and child physicals, and more recently, Medicare wellness visits, and more.’
The article also notes that the expected influx of newly insured patients under the Affordable Care Act provides both opportunity and uncertainty for the retail clinic model, according to the lead author of the study, Ateev Mehrotra, MD.
“If more people are seeking primary care, and there is no dramatic increase in the number of primary care physicians, we could face a situation of increased demand and worsening access. Without an alternative, more patients may go to a retail clinic,” he said. “The flipside is that a significant segment of patients who go to a retail clinic don’t have a primary care physician. If under healthcare reform more people gain access to primary care physicians, it’s still possible they could choose the physician’s office over the retail clinic.” Mehrotra is a policy analyst at the RAND Corporation and an associate professor of medicine at the University of Pittsburgh School of Medicine.
According to Cain, family physicians have responded to the demand for greater flexibility by expanding access to appointments. “Family doctors have responded so that about 75 percent of their offices have open-access, same-day appointments and about half have evening or weekend office hours,” he said. Results from an AAFP physician survey also found that about 31% of respondents offered weekend appointments. Both AMA and AAFP are urging insurers not to give patients an incentive to use retail clinics, warning of the potential for duplicative tests and treatments, higher costs, and lower quality.
As retail clinics have grown in number and ventured into the sphere of chronic disease management, they have also met with stern criticism from some physician groups, such as the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP). AAFP has been vocal in opposing any expansion of the scope of service in retail clinics that approaches managing chronic conditions. It believes that high quality and coordinated care depend on relationships with primary care physicians—a relationship with which retail clinics interfere.
“AAFP believes that the best healthcare comes from a patient-centered medical home, where you have a strong primary care focus with comprehensive, coordinated, and continuing care,” said AAFP president Jeffrey Cain, MD. “When retail clinics start talking about managing chronic disease or performing well adult exams, that’s further fragmenting an already fragmented health system. We believe patients will have better care and better quality if they find that care within an ongoing relationship to a primary care physician who knows that person.” Cain is chief of family medicine at Children’s Hospital Colorado and associate professor in the Department of Family Medicine at the University of Colorado Health Sciences Center in Aurora.
Moving forward, the more doctors (not office managers, staff or nurses), communicate with patients face-to-face and provide other value-driven options, the more those patients will come back again and again and better yet, tell their friends and family to see you too. Afterall, what primary care of family medical practice do you know of today that spends more than forty five to ninety minutes with each patient on every visit?
In surveying thousands of physicians for the nonprofit Physicians Foundation, Merritt Hawkins, a national consulting and search firm in Irving, Texas, recently reported that about 7% of respondents said they were planning to transition to concierge or cash-only practices in the next one to three years.
“We believe the growth rate will be much higher in the coming years – possibly around 15% due to the Affordable Care Act (ACA). Although this is our opinion,” adds Sykes, “we have certainly seen an increase in physician interest to support it.”
Overall, concierge medicine and direct primary care is thriving in major metropolitan markets and prices are dropping dramatically due to increasing competition among physicians entering the marketplace, retail medicine pricing, price transparency demand from patients and uncertainty about the implications of the Affordable Care Act.
“Instead of viewing the status quo PCP model as the center of the universe,” notes Nelson, “maybe we should take some plays from the Retail Clinic playbook before we become obsolete.”
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