Health Insurance and You!

Since the first in-store clinic opened its doors in 2000, CVS, Walgreens, Target, Rite-Aid and of course, the big daddy of them all, Wal-Mart have opened more than 1,200 clinics, and served more than 3.5 million customers, according to the Convenient Care Association. After a decade of experience, and with near-universal coverage only a breath away, it is a good time to evaluate the success of in-store medical clinics, and to determine the changes needed in order for them to be an important channel in the health care delivery system.

There is no question that these clinics, staffed by nurse practitioners and physician’s assistants are enjoying some success. In a recent study published in the Annals of Internal Medicine, a publication of the Journal of American Medical Association (JAMA), researchers compared retail clinics with physician visits, urgent care centers and emergency room visits* for three common ailments – ear infections, sore throats and urinary tract infections. They measured patient costs, quality of care and whether or not patients received any preventive care, such as routine tests, as a result of the visit.

• Cost: The study found that retail clinics were less than two-thirds the price of physicians’ offices and urgent care centers.

• Quality: Quality of care was found to be essentially equal to physicians’ offices and urgent care centers.

• Preventive Care: Follow-up preventive care in retail clinics was similar to that received by patients in physician’s offices and urgent care centers.

* Emergency room visits for these common ailments were substantially more expensive, provided lower quality care and resulted in fewer preventive care follow-up tests.

But there are significant challenges to be met in order for retail clinics to serve both their shareholders and their communities.

• Adding services to compensate for seasonality: In- store operations excel with regard to colds and minor infections, most common during the winter months. But, they are struggling at other times of the year. This past summer, MinuteClinic, CVS Caremark’s clinic division, temporarily closed 89 of its 545 locations. To meet this challenge, MinuteClinic has dramatically expanded its services to treat non-seasonal conditions such asthma and diabetes management, vaccines for HPV and shingles, school and sports physicals and more.

• Managing criticism from doctors: Concerns voiced by medical associations include the threat to public health from clinics over-prescribing antibiotics, patients failing to maintain relationships with their primary care doctors and the inability of clinics to expand their offerings to non-episodic illnesses.

Retail clinics will have to use data such as the results of the JAMA study quoted above, to show patients and policymakers that physicians’ concerns are unfounded. For example, that study found that clinics prescribe antibiotics at the same rate as doctors and that patients receive an equal amount of preventive care. Similarly, data can be used to show that clinics are alleviating the burdens of treating non-urgent cases in emergency room and physician’s offices, allowing doctors to treat sicker patients.

• Serving the under-served: As providers of medical care, retail clinics are expected to benefit society, and should be accessible to needy populations. As publicly held corporations, they are required to return profits to their shareholders, and therefore tend to be located in more affluent neighborhoods. In fact, a separate report conducted by the Annals of Internal Medicine, showed that most clinics were not located in areas with greater medical need. The authors of the study conclude that operators of retail clinics must reconsider their location strategies in order to be an integral player in the future of health care delivery.

With health reform, we are expecting physician shortages and long waits for care. It seems we have no choice but to increase accessibility to non-emergency care. With a ten-year head start, retail clinics are positioned for a major role in our national health care delivery system.

What are your thoughts? Can clinics serve shareholders and patients? Do clinics erode the critical relationship between doctor and patient? Would you go to your local Wal-Mart for medical care?