Whitney Palmer

Retail Health Clinics on the Rise

Published in the April 12, 2o12, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

They’re in nearly every drug store, ready to provide a flu shot, answer questions about a skin rash, or conduct a blood pressure screening. And, every year, more retail health clinics (RHCs) appear to meet patient needs at an opportune time and place.

But with their increasing use of health information technology (HIT), RHCs are quickly moving from being clinics of convenience to being helpful partners in the overall healthcare system. This beefed-up use of technology makes it easier for patients to keep their doctors looped into their health history.

Although these clinics aren’t intended to be permanent or full-service medical homes, they do offer a wide variety of services that supplement the preventative care patients receive from their primary care providers. For example, patients can go to RHCs for routine cholesterol and blood pressure screenings; a variety of vaccinations; or treatment of respiratory infections, allergies, or some skin conditions.

The clinics are also a more affordable avenue for people who need care, but find themselves outside of the healthcare system. Data reported by the American Academy of Family Physicians has estimated a $40 service in an RHC could potentially cost more than double that in a doctor’s office, $120 in an urgent care facility, and $325 in an emergency room. Given that 16 to 27 percent of clinic patients have no health insurance, based on a 2011 RAND report, and only 39 percent have an existing relationship with a primary care provider, the lower cost could be beneficial not only to the patient’s pocketbook, but in the prevention of potentially future healthcare costs associated with developing chronic conditions.

“Retail health clinics are a huge convenience to patients,” said Mary Griskewicz, senior director of health information systems with the Healthcare Information and Management Systems Society (HIMSS). “They can be screened, get their flu shot, have a rash examined, and all of this is usually within 20 feet of the pharmacy where they can get medication.”

The Rise of the Retail Health Center
When RHCs first entered the market, some in the healthcare industry pushed back. Even though they are staffed by qualified nurse practitioners and physician’s assistants, many physicians contended they were inadequate clinical settings that should only be used in the most extreme circumstances.

Now, however, that opposition is disappearing, and RHCs are flourishing. In a healthcare environment where greater access is often the name of the game, a growing number of industry leaders now see these clinics as valued partners in providing preventative and primary care services.

“You are starting to see a newfound cooperation in the marketplace between retailers and their local hospital systems and physician groups,” said Thomas Charland, chief executive of Merchant Medicine, a research and consulting firm that tracks retail medical care service growth, related in a New York Times blog post earlier this year. “Physicians’ resistance is slowly melting away.”

The population of RHCs seems to have ballooned after two years of near-stagnant growth. Between 2010 and 2011, the number of these clinics rose by 11.2 percent to 1,355 nationwide. And, this trend shows no signs of slowing.

To date, retail drug stores, including Walgreen’s and CVS, have been the RHC leaders, with their Take Care Clinics and MinuteClinics, respectively. Currently, Walgreen’s has 350 Take Care Clinics nationwide, as well as 350 worksite locations. In addition, Walgreen’s announced last month that it will expand its relationship with the Tufts health plan in Massachusetts. CVS also has a considerable RHC presence – 650 MinuteClinics and a plan to add 500 more over the next five years.

Other retail giants, such as Walmart and the grocery store chains Kroger and Safeway, have launched RHC efforts within the last year.

Major hospitals and health systems are also adding clinics in retail areas in an effort to meet patients where they live and work. Recently, the Mayo Clinic opened its “Create Your Mayo Clinic Health Experience” in Minnesota’s Mall of America.” Mayo Clinic believes healthcare in the future won’t be limited to doctors’ offices and hospitals. Medicine needs to adapt to peoples’ changing needs, including seeing people where they are and when it is convenient for them,” said David Hayes, M.D., the clinic’s medical director, in an interview with FierceHealthcare. “Mall of America is the ideal gateway for many of Mall of America’s visitors to access Mayo Clinic in non-traditional ways.”

Connecting Patient Information
Despite being exempt from most Meaningful Use requirements and ineligible to receive incentive payments, HIMSS’ Griskewicz said implementing an electronic health record (EHR) is the most important HIT solution an RHC can employ. The nurse practitioner or physician’s assistant won’t complete the same level of patient history intake as a doctor’s office does, but an EHR allows them to document the encounter in some way. Patients can also potentially leave the clinic with access to an electronic copy of the record meant for his or her primary care physician.

According to Gabe Weissman, external relations manager with Walgreen’s, the company jumped head-first into HIT and developed its own EHR. The system allows any Walgreen’s nationwide to access a patient’s health records. For example, a provider in one of the Take Care Clinics can access the health records of a Pennsylvania resident who needs healthcare while on vacation in Florida.

“We’re working to ensure patients realize there are alternatives to the emergency room. We’ve formed relationships so nurse hotlines in hospitals are aware of Take Care Clinics and can route people there for services that aren’t appropriate for the ER,” he said. “We make sure we’re sharing records with primary care providers in the appropriate health system while filling a niche for slightly less emergent care.”

Walgreen’s also offers online appointment scheduling and recently launched an initiative through the social network Foursquare. Patients can use the smartphone application to electronically refill prescriptions, transfer prescriptions between Walgreen pharmacies, and schedule reminders to take medications.

The retailer’s Take Care health system was recently awarded Pointclear Solutions’ HIT Innovation Award for 2011 in recognition of its “innovation of online tools that allow patients, physicians and pharmacists to interact in near real-time, making patient health and wellness incredibly efficient for all participants, moving the healthcare industry dramatically forward,” according to a recent Pointclear press release.

One big challenge to fully utilizing an EHR still remains. There is often limited coordination between the RHC and a physician’s office or hospital. There simply are not enough resources available to safely and successfully link the RHC’s system with the wide variety of EHRs used by other clinical settings in each geographic area.

“The one problem with this situation is that there isn’t full EHR interoperability between pharmacies, hospitals and physicians,” she said. “Even if retail clinics are using an EHR, if it isn’t tethered to a physician’s office, the doctors aren’t getting the full picture.”

The one exception is e-prescribing – the only Meaningful Use requirement that does affect RHCs. Using e-prescribing services, such as Surescripts’ Clinical Interoperability, links provider, pharmacy and payer, and eliminates the need for pharmacies and physician offices to fax or mail prescription orders and patient information. Instead, with a few keystrokes, RHCs and providers can partner to compile more thorough patient histories that will lead to better, more efficient care in the future.

Griskewicz cautioned, however, that without proper staffing to fill the medication orders sent via an e-prescribing tool, the interoperability is ineffective.

More To Come
As quickly as RHCs are expanding, so are the HIT solutions to support them. Griskewicz predicted that most growth will occur with mobile technology, giving RHCs the ability to give patients their health information in easy-to-transport formats. The overall impact, she said, will be a positive effect on patient health and well-being.

“I encourage retail clinics. I encourage them to continue to use health information technology to work with outside organizations,” Griskewicz said. “They should continue down this path as technology evolves to make these health services more convenient for patients. It’s not just about bringing customers in and selling the candy on the shelves, but about improving the health of the patient.”

To read the article in its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/April/Retail_Health_Clinics_on_the_Rise.html

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