Convenience and Continuity of Care in the Evolving Retail Clinic Model

By Jenna Haines
Sunday, September 1, 2019
Specialty: 

Industry observers and insiders ponder the role of retail clinics in modern health care and how that squares with physician-patient relationships.

Retail clinics — typically housed in pharmacies or grocery stores — provide a number of non-emergency health services, including immunizations, sports physicals and treatment for acute respiratory infections and other minor illnesses, on a walk-in basis.

Since the first such facility opened in 2000 — a Minnesota MinuteClinic, a brand that CVS Health acquired in 2006 and currently the largest provider of retail clinics in the U.S. — the number of retail clinics nationwide has grown to more than 2,700.

Meeting Patients Where They Are

Key to the appeal of retail clinics is accessibility. Often located in patients’ neighborhoods, they offer shorter wait times and evening and weekend hours.

“In this consumer culture in which we live, convenience is at a premium,” says Kosali Simon, PhD, health economist at O’Neill School of Public and Environmental Affairs at Indiana University in Bloomington. “Everyone is busy, and more services are catering to this reality. We can have our groceries delivered. We can purchase and receive items off of Amazon within hours. We have come to expect convenience in lots of ways. Yet, it can still be incredibly difficult to make an appointment with a primary care provider within a reasonable frame of time.”

Signage and visibility help drive the retail clinic phenomenon as well.

“Retail clinics essentially have a built-in marketing campaign,” says Colin Carr, Founder and CEO of Denver-based Carr Healthcare Realty. “By being located in a shopping area with heavy traffic, retail clinics have an increased amount of effortless exposure.”

“It feels as if we’re on the cusp of a major shift in health care, but we don’t know how it’ll play out. High-quality care is expensive to receive and provide, and as a result, both patients and providers are looking for options that cost less without resulting in a reduction of care.”
— Kosali Simon, PhD, Health Economist at O’Neill School of Public and Environmental Affairs at Indiana University in Bloomington

Continuity of Care

Skepticism remains about this model of care, however. Some providers fear retail clinics may discourage patients from seeking treatment from a single primary care provider, undermining continuity of care.

Yet statistics by the Rand Corp. show that the majority of patients in retail clinics do not have a primary care provider at all, suggesting the facilities serve patients who might not be receiving care otherwise. Moreover, say defenders of the model, retail clinics can actually play a role in promoting the physician-patient relationship.

“MinuteClinic encourages consumers to have a primary care provider, and we offer patients a resource list of primary care providers in the region who are accepting new patients,” says Sharon Vitti, Senior Vice President of CVS Health and President of MinuteClinic. “In fact, in 2018, we made more than 2 million physician referrals for patients who did not have an established medical home. ... In addition, to help promote continuity of care, a MinuteClinic visit summary is sent to the patient’s primary care provider with patient permission after each visit.”

Further, some retail clinics, including MinuteClinic, collaborate with traditional health systems to provide patients integrated care that is reflected in their EHR.

On the Move?

Retail clinics are often in affluent, more densely populated neighborhoods. In fact, according to Rand, only 12.5% are in medically underserved areas. Simon hopes this will change in the near future.

“What we have seen in the past is that these medical advances tend to happen in areas that already have more resources,” she says. “While this business model may be more profitable, they can have a bigger impact by going into these more rural geographic areas where disparities exist and healthcare options are limited.”

Simon also hopes to see retail clinics continue to partner with other healthcare systems and capitalize on advances in telemedicine.

“Can the lack of resources in a retail setting be compensated by virtual integration with more traditional healthcare landscapes?” she asks. “Will I, one day, be able to go into a retail health setting and see a provider that, with the click of a button, can connect me to an expert with specialty training who has access to my medical information and charts? I think it certainly would not be surprising, given all the transitions and innovations occurring in other industries. Plus, it is really important. We need quality health care more than we need our groceries delivered.”