One Stop Shopping: The Trend of Retail Healthcare

  1. It’s no secret that healthcare continues to change and evolve. Most of the changes are great, but even with improvements, there are things that go to the wayside. As consumers, we demand service that is cheap, quick and good. So goes it in healthcare. With the emergence of retail healthcare, we see pop up clinics that provide non-emergent healthcare treatment, dental care, and even dermatology clinics.

    One Stop Shopping: The Trend of Retail Healthcare

    Americans thrive on being able to access things quickly. Drive-thrus give us our coffee, hamburger, or prescription through our car window. We are busy people, and this allows us to multitask without dragging the kids or dog out of the car. We can't see a doctor or nurse practitioner through our car window, but we can stop at our convenience at a clinic on the corner or in the grocery store for our UTI. That is retail healthcare. As Jeannette Y. Wick RPh, MBA tells us in the article, "Retail Health Care: Where It's Been, Where It's Going", there has been a shift in the recent years away from the emergency room for those non-emergency healthcare problems such as bronchitis or that rash on your belly. The cost is less for the patient, and valuable resources are not held up when an urgent care clinic is visited instead of a hospital emergency room that is trying to help a person in a real crisis.

    Retail healthcare is attractive to the consumer, but for the investor, it is even more so. "What's Behind the Surge in Retail Healthcare Deals?" written by Nirad Jain, Jeremy Martin and Kara Murphy explain that, "From 2012 to 2017, the number of deals involving retail health companies-those that operate freestanding health-related outlets like dental clinics or urgent care facilities-has soared, increasing at a compound annual rate of 34%" That is a large number, and for investors it means a good return. The owners examine it from the patient's side as well as a business side to find the best solution for both parties, their competition is the patient's (consumer's) reward.

    The investing companies are dependent on the consumer and the consumer has a choice whether to use them or not. This makes the company look at patient proximity, specialization of care, cost, and last but not least customer satisfaction. Patients are becoming self-advocates. One out of three patients look online for a diagnosis and 41% say that a medical professional confirm their diagnosis according to the article by Gary Druckermiller, "What Can the healthcare Industry Borrow From Retail Marketing?".

    We've already seen the upside to this form of healthcare: a variety of health care services, close proximity to patients, less cost to the patient, less wait times, profit for the owners, and standardized protocols. There are some issues that have to be taken into consideration regarding retail healthcare. No company can provide everything to everyone, so they have to cater to the "most valuable" according to Jain. Knowing the patient's needs coupled with the business side of knowing the regional market is a must for their success.

    Another issue for the corner clinics is keeping doctors and nurse practitioners. Recruitment for this type of job is not easy and not having the proper number of clinicians can back up the patient load and eventually, the consumer will go somewhere else. There is a fine balancing act by the investing companies that goes into these clinics. Reimbursement looms as an ever-changing factor for these clinics, making the owners concerned. As reimbursement changes, especially if it increases, will roll down to the customer and possibly increase the rates.

    Continuity of care for the patient is very important. Guiding a patient over time and making sure they receive the proper care can get lost if the primary physician is not informed. For example, it a patient visits a clinic for a UTI, the primary doctor doesn't necessarily get notified. One time is fine, but if the patient is having frequent UTIs and goes to more than one clinic, a diagnosis could get missed. The patient could potentially have other issues going on that require more intense studies. A breakdown in the patient to primary relationship will happen if the patient solely relies on the clinics therefore, the continuity of care will be fractured.

    In a study cited by Jeannette Y. Wick in her article, "Retail Healthcare: Where It's Been, Where It's Going," she tells us that between 2008 and 2015, 21 million uninsured people made 52 million visits to urgent care clinics. The use of urgent care has increased greatly and will continue to do so. In fact, they have increased by 93%

    With the multiple advantages of retail healthcare, there can be a downside. With all the conveniences, patients may go long periods of time not seeing the primary and miss doing essential exams, or fall through the cracks on a diagnosis. Have you seen it effect your patients?

    References
    Druckenmiller,Gary. "What Can the Healthcare Industry Borrow From the Retail Marketing?" Evariant. 14 January, 2016. 29 August, 2018. Web.

    Jain, Nirad., Martin, Jeremy., and Murphy, Kara. "What's Behind the Surge in Retail Healthcare Deals? Bain & Company. 9 May, 2018. 28 August, 2018. Web.

    Wade, Evan. "Investigating the Rise of Retail Clinics." HealthCare News. 11 April, 2018. 28 August, 2018. Web.

    Wick, Jeannette Y RPh, MBA. "Retail Health Care: Where It's Been, Where It's Going". Contemporary Clinic Pharmacy Times. N.d. 29 August, 2018. Web.
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    4 Comments

  3. by   BostonFNP
    In my practice I see both the good and the bad of retail health. Overall I think it is good for the system and for patients, though I have some reservations about the increasing forays into preventative medicine.
  4. by   tnbutterfly
    Quote from BostonFNP
    In my practice I see both the good and the bad of retail health. Overall I think it is good for the system and for patients, though I have some reservations about the increasing forays into preventative medicine.
    Thanks for the comment. As an NP, can you please expand on your reservations.
  5. by   BostonFNP
    As many know, I work in a PCP role as a partner in an internal medicine practice. Most of the people I care for are older complex medical patients.

    Positives:
    1. Retail health clinics are much better medication stewards than the ED or UC, from opioids to antibiotics, patients are much more likely to receive guideline treatment and not more.
    2. Retail clinics keep many non-emergency cases out of the ED.
    3. Retail clinics give me a good option when I am on call coverage (I don't have to send folks to the ED but I also don't have to treat them without seeing them).
    4. Retail clinics do a good job (perhaps too good) with ensuring patients have vaccinations.

    Negatives:
    1. For a lot of my complex medical patients a cookie-cutter approach to diagnosis and treatment doesn't work very well, things are not blank and white, and nothing is ever in isolation from everything else. Even moderately complex diagnoses are often missed because they don't fit the algorithm. I worry that there is too much focus on the tree and very little on the forest.
    2. They don't have access to much diagnostic testing or specialty care nor a good system to follow-up on patients that might need it.
    3. They don't know the patients like I do and they are limited in their ability to use clinic instinct and judgement both because of this and because of their guidelines.
    4. Patients end up there for things they should have gone to the ED with and there is nobody doing triage if the provider is busy.
    5. I don't love that their employer is a pharmacy it feels like there could be a conflict of interest.
  6. by   Brenda F. Johnson
    Quote from BostonFNP
    As many know, I work in a PCP role as a partner in an internal medicine practice. Most of the people I care for are older complex medical patients.

    Positives:
    1. Retail health clinics are much better medication stewards than the ED or UC, from opioids to antibiotics, patients are much more likely to receive guideline treatment and not more.
    2. Retail clinics keep many non-emergency cases out of the ED.
    3. Retail clinics give me a good option when I am on call coverage (I don't have to send folks to the ED but I also don't have to treat them without seeing them).
    4. Retail clinics do a good job (perhaps too good) with ensuring patients have vaccinations.

    Negatives:
    1. For a lot of my complex medical patients a cookie-cutter approach to diagnosis and treatment doesn't work very well, things are not blank and white, and nothing is ever in isolation from everything else. Even moderately complex diagnoses are often missed because they don't fit the algorithm. I worry that there is too much focus on the tree and very little on the forest.
    2. They don't have access to much diagnostic testing or specialty care nor a good system to follow-up on patients that might need it.
    3. They don't know the patients like I do and they are limited in their ability to use clinic instinct and judgement both because of this and because of their guidelines.
    4. Patients end up there for things they should have gone to the ED with and there is nobody doing triage if the provider is busy.
    5. I don't love that their employer is a pharmacy it feels like there could be a conflict of interest.
    Thank you for your insight. I think what worries me most is what you talked about in 1 and 2, lack of follow up and missing an important diagnosis because they are not looking at the whole patient like the primary caregivers.

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