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Shopping for Care: Retail Clinics Bring New Meaning to Shopping, and Healthcare

mallThe newest trend in healthcare may be coming soon to a mall near you.

Health insurance companies are opening insurance outlets to:

  • Help consumers find individual and small business insurance plans, and to
  • Help folks complete insurance applications.

Pennsylvania’s Highmark Inc. is planning to launch two such stores this year, one near Pittsburgh and another outside of Harrisburg.

The two stores will be similar to outlets opened by Florida’s Blue Cross Blue Shield last year.

The stores will provide:

  • Kiosks with computers for folks to do research;
  • Meeting rooms for informational sessions; and
  • Private rooms with video equipment for consumers to speak directly to specialists from a central location about questions or complaints they might have.

The point of the stores will be to promote sales, says an article published in our local Pittsburgh Post-Gazette.

But the sales associates “must also be prepared to deal with angry and emotional customers who don’t understand their plans or who have been denied coverage.”

Do these stores represent the future of insurance sales?

  • As more employers drop coverage, folks are scrambling to buy insurance on the individual market.
  • Insurers realize that people need help to figure out how individual plans work.

If health care retail clinics are any indicator, the success of the insurance outlets is far from guaranteed.

What are health care retail clinics?

Hailed for their convenience (long hours, same-day appointments) and price transparency (low prices that are easily visible), health retail clinics spread quickly after first opening in 2000.

In 2006, there were only 60 of these stores in 18 states, but by the end of 2007, there were 900 clinics spread over 30 states.

Patients can receive basic medical services at the health clinics, which tend to have names like MinuteClinic, QuickHealth and CheckUps. Examinations and vaccinations are usually administered by nurse practitioners, which helps to keep costs low, but which has raised concern amongst doctors and state regulatory agencies.

Why do individuals go to a health retail clinic?

According to the annual Health Tracking Household Survey, which is conducted by the Robert Wood Johnson Foundation, the reasons for visiting a clinic include:

  • To have a new illness or symptom diagnosed;
  • To refill prescriptions and receive vaccinations; and
  • To obtain care for a chronic condition.

The inexpensive services provided by the clinics have proven popular with uninsured individuals and families, as well as with those folks who have high-deductible health plans (HDHPs) and would otherwise skip or delay preventative visits.

  • This study shows that retail clinics are cheaper for patients than going to a primary care doctor.
  • The retail clinic “CheckUps” estimates that 30% of its patients do not have a family doctor.
  • Uninsured clinic consumers were 3.5 times more likely than their insured counterparts to cite the low costs as a major reason for patronizing the retail clinics.

So what’s the problem with the clinics?

Despite the convenient and reasonably-priced services offered, most Americans have yet to visit a retail clinic. Clinic growth is slowing as a result. It was once predicted that there would be 6,000 such clinics by 2012, but clinics are now closing their doors left and right.

  • A survey that looked at clinic usage in 2006 and 2007 found that only 2.3% of American families had ever visited a health outlet, which means that the vast majority of U.S. residents have never received care in a retail clinic setting.
  • Even when the statistics were adjusted to account for a higher number of clinics in a given area, the total usage rates were still very low.

This is true even though most major public and private insurance providers now cover visits to the clinics, which removes one potential barrier. (The clinics take cash payments from those without insurance.)

Why is the retail clinic experiment faltering?

The retail clinics require a significant investment to get them up and running past the break even point (between $300,000 and $600,000 each).

Each clinic must also treat between 25 and 30 patients per day to remain profitable. It can take up to two years to attract this number of patients. It is especially difficult to reach this goal since many Americans are still unaware that the clinics exist. Clinics must spend a lot of money to advertise their services, much in the same way that private insurance companies do.

And in our shaky economic climate, investors are less and less willing to wait before seeing a solid return on their money.

Retail clinics are a for-profit venture, and they have been unable to satisfy the main requirement of any for-profit venture, which is to generate and return profits to shareholders and investors.

What does this mean for consumer-driven healthcare reform initiatives?

We are often told that the best way to solve the healthcare crisis is to encourage and allow for innovative, market-based solutions.

For example: Prices for medical services too high?

  • Market-solution: Let the number of private providers expand unchecked so that they must compete for patients by lowering their prices. (We’ll discuss why this solution is a problem in the near future).

We’re not saying that all market-based plans are bad, or doomed to failure.

In the case of retail clinics, some experts believe that these stores hold tremendous potential for providing low-cost preventative services to uninsured or underinsured folks, which might cut back on more costly visits to the ER.

And if the number of people that visited the clinics on a regular basis increased exponentially, the clinics could help to drive down the cost of care offered by competing medical providers.

But we have to ask: are market-based initiatives the cure-all for our healthcare system?

Or do we just want to believe that they work, even when the hard data tells us there are problems?

In a coming post, we’ll discuss the fallacies behind the free-market approach to healthcare reform, while also looking at examples of successful market-driven plans.

{ 1 comment… add one }
  • Dan February 28, 2009, 4:02 pm

    One possible solution to the occasional lack of access to, or shortage of, primary care doctors is what are known as retail care clinics, or convenience care clinics. The popularity of these clinics continues to increase progressively for a variety of reasons.
    Of particular note is that most of these types of clinics is that are normally staffed with nurse practitioners or physician assistant. Both are health care providers and are actually favored by many as treatment providers progressively. Surveys reveal that over half of all people prefer seeing a nurse practitioner at a convenience clinic because the visits do not take up so much of their time, as well as the visits being less expensive than traditional doctor visits.
    The growth of such clinics, and the patient volume of each clinic, may slow at times, but the unique benefits of such urgent care light clinics do in fact exist and are desirable for many. While the first retail clinic began in the year 2000, presently, there are over 700 of these convenience care clinics, and that number is speculated by some to increase to thousands within the next few years.
    First, I’ll offer a definition of a retail clinic:
    A retail clinic is a medical treatment facility that is usually located in a convenient location, such as a shopping area, and is smaller than most doctors’ offices in regards to geographical space. Again, these types of clinics are staffed with a physician assistant or nurse practitioner.
    Both types of these health care providers have the ability and authority to provide the same quality care as a primary care physician, and do so with the same if not superior standards regarding accountability and autonomy.
    If you happen to go to one for what may be considered a mild ailment, for example, for such conditions as allergies or the flu, you will notice a unique and pleasant experience regarding your medical care at such a clinic in comparison with many other doctor’s offices that often appear to be possibly demoralized if not largely apathetic, in regards to their disposition.
    These urgent care light clinics are normally and amazingly quick for a patients who are medically treated at such locations. You as a patient are normally in and out of there within a half hour or so. This includes a thorough assessment and treatment regimen offered by the health care providers at such clinics.
    Unlike typical doctor offices, these clinics are walk-in clinics, so there is no over-booking of patients, which is what typically occurs at current offices of doctors. Many are focused on the daily volume of patients for a variety of reasons.
    With these convenience care clinics, you as a patient actually dialogue with your health care provider more so than you may have experienced in a traditional doctor’s office due to possibly other doctor offices often being incredibly busy from seeing too many patients during a typical day for reasons described above.
    And this is not to imply that the health care providers at typical doctor offices do not care about you and your particular health issues, yet possibly is a result of having limited resources related to patient care. As a result, they may be unable to do so.
    The cost of going to such a retail clinic typically is about 25 percent less expensive than a normal doctor visit, others have said. Yet you will likely notice no decline in the quality of care that you receive. In fact, likely you will experience greater quality on many different levels, both from a personal level and treatment level if a patient at such a clinic as a retail clinic, others have said.
    Critics of such convenient care clinics include the American Medical Association, and various medical societies. Yet in my opinion, such critics may be simply vexed because of the invasion of these other clinics on their turf and their infiltration into their typical medical practice paradigm without being invited, perhaps.
    Or maybe such groups and associations do not see NPs and PAs as having the ability to provide quality medical care as they do as medical doctors. Regardless, most patients seem pleased with the retail clinics and the treatment providers who care for them at these convenience care clinics..
    If it is discovered that you need greater medical care or attention than the retail clinic can provide for you during your visit at a urgent care light clinic, you will most likely be referred to a nearby location that can provide the care you are determined to need by the clinic’s heath care provider.
    The clinic’s health care provider likely has some familiarity as well as some relationships with the hospitals and others in the medical community for which they serve. It should be noted that both NPs and PAs are quite capable of determining the severity of your illness, and will act accordingly.
    So most patients of these retail clinics are pleased with the care they receive from them, which is why such clinics continue to grow in number under different names, as they have become franchises, yet the concept of this ‘pay as you go’ health care is fairly new.
    So only the future will tell if this method is preferred by those seeking minor restoration of their health. It seems to be preferred by many presently, once again. And presently, Take Care Health Clinics, owned and located inside Walgreen’s pharmacies, are the market leader with retail clinics. Walgreens plans to add more clinics next year.
    These retail clinics are in a way a response to the shortage of PCPs that exist presently, and delays others experience in our health care system when they seek restoration of their health on occasion. In other words, retail clinics are quick when you are sick, yet quality and assessment of your medical condition are not compromised.
    One could conclude that the retail clinics seem in a way more authentic than the dominant system, and may be more beneficial ultimately for the public health, with exceptions, of course, depending on the individual circumstances of the patient.
    Dan Abshear

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