Soapbox

Retail clinics an important piece of health care system

Mary Hull, left, a nurse practitioner, examines Blake Howard, 12, at the Minute Clinic at CVS pharmacy in Arcadia in 2012. Retail health is still in its infancy as a means of delivering health care, yet it has already proven to be an effective supplement to traditional models.
Mary Hull, left, a nurse practitioner, examines Blake Howard, 12, at the Minute Clinic at CVS pharmacy in Arcadia in 2012. Retail health is still in its infancy as a means of delivering health care, yet it has already proven to be an effective supplement to traditional models. Los Angeles Times file

The next time you visit Walmart, you might want to ring up a health check-up along with your groceries and electronics. Big-box retailers and pharmacies have begun a push to provide health care services through retail clinics. Wal-Mart, Target, CVS and Walgreens are a few of the notable names leading this effort, which has the potential to fundamentally change the way we deliver primary care.

Retail health clinics are a simple idea. For the most part, they are walk-in clinics located in retail outlets. Customers can be evaluated for minor health complaints and receive treatments. The clinics are generally staffed by nurse practitioners or physician assistants.

The model is now expanding. Some retail clinics have introduced telehealth kiosks through which patients can access a physician via videoconference in real time. Others are developing specialized programs and preventative services to improve long-term health. For example, CVS smoking-cessation programs give smokers ongoing guidance and support. In the past few weeks, Kaiser Permanente and Target announced the launch of four Target clinics in California that provide extensive wellness services, including chronic disease management.

With their rapid and continuing growth, retail clinics have transformed from a store-by-store novelty into a way to address the two great challenges of American health care: cost and access.

Health care spending currently accounts for approximately 17 percent of GDP, and a Centers for Medicare and Medicaid Services report released this year found that spending will likely accelerate over the next 10 years. Retail clinics have shown that they can be part of the solution. Several studies have compared the cost of a visit to a retail clinic vs. a doctor’s office and found that retail clinic visits average 20 to 40 percent less. Given that these visits tend to be for routine illnesses, they also do not sacrifice quality of care.

While the cost savings are substantial, retail clinics’ ability to increase access to care may be even more important. The fear of a physician shortage is one of the most discussed concerns in health care. Demographic factors and an influx of patients after the passage of the Affordable Care Act have intensified the issue.

Once again, retail clinics can help alleviate the problem. There are more than 1,600 in the country, and the number is expected to approach 3,000 in the next year. Because of their location in pharmacies and large stores, the clinics are typically easy to access. More than 90 percent of Californians live within 5 miles of a pharmacy. I could provide more statistics, but instead, just think about how long it would take you to get to a CVS or Walmart. The convenience also entails more than geography. Retail clinics are open longer than a typical doctor’s office and have minimal wait times.

Unsurprisingly, customers have responded well to the clinics. There was over a 600 percent increase in visits between 2007 and 2012, and a Harris Interactive poll found that more than 90 percent of patients were satisfied with them.

Establishing retail clinics as a first line of primary care for some conditions would increase physicians’ bandwidth as well. Doctors would be able to manage more overall patients but focus their time on patients with more complicated disease.

There are still a few issues that need to be addressed in the conversation surrounding retail health care. First, there is some concern about the impact of the clinics on the doctor-patient relationship. It is true that patients going to walk-in clinics would be spending less time with their physician, but that’s not a bad thing. Many patients prefer the convenience of retail clinics. And doctors are able to spend more time with the patients who need them most.

Second, there are fears that conflicts of interest could impact care. A caregiver employed by Wal-Mart might have an incentive to encourage patients to return to the clinic. After all, each time they come in, they might buy something on the way out. Regulatory oversight may be necessary to ensure patient safety.

Lastly, some physicians worry that patients will go to retail clinics with problems that are beyond the capacity of the clinic and will receive substandard care. For this reason, it is important to maintain a physician presence – which doesn’t have to be physical – for consultation when necessary.

Retail health is still in its infancy as a means of delivering health care, yet it has already proven to be an effective supplement to traditional models. Moving forward, it should become a critical piece of the health care system.

Akhilesh Pathipati is a Stanford medical student and Harvard graduate who has worked on health initiatives in

Massachusetts and California. He is a Sacramento native.

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