Collaborating with Retail Health Clinics

There are approximately 1,400 retail health clinics in the U.S. today, according to a report by Accenture, and that number is expected to double over the coming three years.

The reason for the growth, industry executives agree, is basic supply and demand.

“The CDC estimates 10,000 people a day are aging into Medicare age and, as we know, as you get older you require more services, more visits, more imaging, more lab work,” says Alan London, MD, chief medical officer for Walgreen’s Take Care Clinic. “So the demand is growing based on the population growing and aging, and a declining number of physicians, especially primary care physicians, for that population.”

In addition to the aging population, implementation of the Affordable Care Act will put more consumers without existing relationships with primary care physicians into the system, adds Webster Golinkin, chief executive officer of RediClinic, the nation’s largest independent operator of retail-based convenient care clinics.

Those two trends, according to the Accenture report, will “add capacity for 10.8 million patient visits per year, compared to 5.1 million in 2011.” They will also, say industry executives, mean collaborative opportunities for physicians.

Working together

The perception exists that retail health clinics, or convenient care clinics, are in direct competition with medical practices. But Take Care’s London says nothing could be further from the truth.

“We do not intend to be the primary medical home,” London explains. “We want to be an extension of the physician practices, the physician network, the primary care medical home. So, whether it’s an independent physician, a large single-specialty primary care group or a large multi-specialty medical group, we want to work with that group and be available to their patients after hours as a cost-effective alternative to the emergency room for all of the patients’ needs.”

Golinkin says that recent legislation in Texas, where all of RediClinic’s facilities are located, makes less difficult for physicians to work in collaboration with retail health clinics. At present, a physician has to be on site 10% of a clinic’s open hours. The new legislation, which was supported by the Texas Medical Association and takes effect in November 2013, eliminates the physician on-site requirement.

“Ten percent of our open hours is basically one day a week,” Golinkin says. “And, so, if they had a practice, our oversight physicians would have to take a day off from their practice. And it was challenging because our clinics are small, so there’s really no place for a physician to be in the clinic, because they’re not treating patients. So, there were space constraints.”

Since a lot of the support physicians provide at retail-based clinics can be done electronically — reviewing charts, for instance — the elimination of the on-site requirement makes it easier for RediClinics to collaborate with local physicians and vice versa, Golinkin explains.

A shared experience

CVS Caremark, the current leader in the retail health clinic, operates 640 MinuteClinics inside select CVS pharmacy stores. Andrew Sussman, MD, president of MinuteClinic and senior vice president and associate chief medical officer for CVS Caremark, says the plan is to grow that number to 1,500 in the next four years. With that growth, he says, will be even more patients who need a primary care physician.

“About 50% of our patients do not have a primary care provider,” Sussman explains. “For these patients, we have a resource list of physicians in the area who are accepting new patients.”

MinuteClinic is also actively forming strategic clinical affiliations with some of the largest and most prominent health care systems in the country.

London says Take Care has the same mentality.

“We feel it’s very important to link [patients] with a primary care physician in combination with the services we’re providing,” he says. “We are forming partnerships all over the country with individual physician groups and health systems with physician practices, and partnering with them both for access for their patients, and for us to have an organized approach to finding primary care and specialists for our patients’ needs.”

Relationship building

Golinkin says that physician and retail health clinic collaboration starts with building a relationship of trust, where both parties recognize that they have certain strengths to bring to the relationship. One of the strengths of the retail health clinic is after hours and weekend care, and Golinkin says that RediClinics have become the referral of choice by many local physicians for that overflow care.

“If a patient can’t get in to see that physician, and they have something that is relatively routine, it’s a lot easier for the patient, and less expensive, for them to go to a RediClinic than to the emergency room,” he explains. “And as long as the physician is assured that we will forward to them a record of the patient’s visit, and that we will view that patient as being a patient of the referring physician, there’s a very obvious complimentary relationship that can be built.”