About one third of the 700,000 practicing doctors in the United States are primary care providers (PCPs). They often work in group practices or are affiliated with larger healthcare systems. The practices are open during daily office hours, with a doctor on call evenings, weekends, and holidays.
Some primary care doctors are trying to reinvent themselves by offering extended hours, weekend appointments, online booking, email access to a doctor, and follow-up care via virtual or telemedicine. Primary care doctors in large numbers are turning to alternative models of primary care. One of the options may be full-service walk-in health clinics in retail stores such as Walmart or at drugstores such as CVS and Walgreens.
The physicians who will find the retail walk-in model attractive are those who are looking for collaborative, multidisciplinary team environments where physicians are the ones who make decisions, not the bean counters in large multispecialty groups and hospitals. The retail model also will attract physicians looking for part-time employment.
The Financial Benefit of Retail Clinics
Because the benefits of retail clinics include convenience, cost-effectiveness, and quality of care, insurance companies will likely embrace these retail-based care delivery models. CVS/Aetna plans to provide community-based access to high-quality care while delivering a more direct, responsive, and affordable patient experience. From the physician’s perspective, retail clinics offer the patient’s care team a more complete picture of their health to drive coordinated care with the most favorable outcomes.
A major complaint from patients is the difficulty of obtaining access to healthcare. It is common, when a patient calls a physician for a nonemergency problem, for that patient to be told that the next available appointment is not for weeks or even months. For example, a patient has flu-like symptoms, and home testing is negative for COVID-19. The first appointment that patient is able to obtain is four weeks away. In most instances, given the natural history of the flu, they will get better without the assistance of a physician! This situation is unsustainable and results in complaints that the American healthcare system is not working. The United States spends $4 trillion on healthcare every year, or nearly 18% of the GDP. Yet many Americans don’t have access to care, experience poor outcomes, or defer medical care, with the resulting progression of disease and rising care costs. This article offers a possible solution to this problem with the model of the retail walk-in clinic.
Why are patients avoiding necessary care? Nearly 50% of patients cite financial concerns as a leading reason.(1) This is followed by the time taken from a patient’s day to visit the doctor, pharmacy, or labs. The third reason is difficulty obtaining an appointment.(2)
The number of Americans who have a PCP is decreasing. A 2016 report from the Annals of Internal Medicine stated that nearly half of insured adults had not seen a PCP in the previous year. Another report, in JAMA Internal Medicine in 2015, found that only an estimated 75% of Americans had a PCP, a figure that had decreased from 77% in 2002. More importantly, for Americans in their 30s, the figure dropped from 71% to 64%.(3)
These patients who do not have a PCP or who have difficulty accessing care tend to rely on emergency or urgent-care options. This results in increased out-of-pocket costs, decreased continuity of care, and limited opportunities for preventive care. It is generally accepted that primary care engagement improves health outcomes and lowers healthcare costs.(4) Retail walk-in clinics offer fast service at nontraditional hours, which may be more appealing than primary care appointments, especially for younger people in good health who don’t have the luxury of waiting in the doctor’s office to be seen by a physician. Now major pharmaceutical chains have announced new options for patients who like one-stop comprehensive healthcare outside of the traditional care setting. These options also offer new opportunities for PCPs.
A paradigm shift regarding primary care is occurring. Walgreens plans to open 500 to 700 primary care clinics attached to its stores over the next five years. These retail clinics will work like a traditional PCP practice, with enhanced convenience, access to telehealth, and in-home visits. CVS has built 1000 MinuteClinics in the United States and plans to convert 1500 stores into HealthHUB locations. These sites will offer healthcare services such as sleep apnea assessments, phlebotomy services, and dedicated space for wellness classes. Finally, Walmart has created two new Walmart Health clinics in Georgia and Arkansas. These are one-stop shops for healthcare featuring primary care, urgent care, diagnostics, x-rays, behavioral health, and dental care services. These retail walk-in clinics are planning to recruit physicians for all these stores.
Their differentiator from the traditional primary care model is transparency and decreased cost. A primary care visit costs approximately $40 for adults and $20 for children.
One other benefit is that this model allows pharmacists and PCPs to collaborate to manage comprehensive care. In the past, physicians have not included the pharmacist on the care team for patients. Pharmacists are a valuable resource, and it is in our patients’ best interests to have them participate in their healthcare. They can help with encouraging drug compliance, avoiding polypharmacy, and providing automatic refills so patients don’t have gaps in their medication.
Importance of Primary Care
In the past, a patient’s doctor took care of all of a patient’s general medical needs, knew their health histories, recommended specialists, and saw them if they were hospitalized. These physicians gave physical exams and vaccines and administered or ordered screening tests. They managed problems such as infections and minor injuries. They also provided care for chronic conditions such as diabetes, hypertension, and arthritis. The PCP coordinated the care of other healthcare providers and served as the captain of the patient’s healthcare ship.
Why is it so difficult for patients to gain access to PCPs? A smaller percentage of medical school graduates choose primary care, opting for more lucrative specialties. The remaining primary care doctors have large patient loads. The contemporary primary care physician manages 1200 to 2000 patients and sees 20 or more patients daily. That, combined with a growing list of administrative tasks and ever-changing regulatory requirements, is causing many primary care doctors to report burnout—which now is more than 50%.(5) It is common for PCPs to spend more time on medical records and administrative tasks than eyeball-to-eyeball with patients. This situation has adversely affected the morale of physicians who went to school to treat patients, not to push paperwork.
Because the baby boomer population is aging—and increasingly likely to require regular, comprehensive care—the need for additional PCPs is growing. The Association of American Medical Colleges predicts a shortage of 55,000 by 2032.(6) Worryingly, there has already been a steep decline in the number of people getting regular primary care. Among people with private health insurance, appointments with PCPs dropped 24% between 2008 and 2016, while appointments with specialists remained the same, according to one recent study.(7)
Evidence supports that patients who get regular primary care have better health. Some providers don’t accept traditional insurance and charge a flat fee. This reduces the cost of care, because the practice can handle the less time-consuming administrative responsibilities. Reduced costs make the practice more affordable for patients with high deductibles, high copays, or no insurance.
Another alternative is charging a “membership fee” and paying for the usual health insurance. This added expense, which is used in the concierge model, guarantees convenience of access and providers answering calls and emails promptly and communicating with patients using telemedicine.
The Retail Walk-In Clinic Model
Both patients and providers are seeking newer alternatives to the traditional options. For instance, almost half the respondents in a 2019 survey on consumer digital healthcare trends say they have used a walk-in or retail clinic, and 29% have used virtual care.(8) Retail clinics first appeared in major chain stores around 2000. About 2000 U.S. retail clinics provide more than 6 million visits a year.(9)
A retail clinic is a health center located within a retail store. These clinics aim to be convenient, affordable options for people with minor health needs, offering an alternative to urgent care centers and hospital emergency departments. Patients often can visit a retail clinic without making an appointment; however, a clinic may encourage patients to make an appointment ahead of time.
Retail clinics typically are located inside grocery stores, pharmacies, and big-box retailers. The clinics are open during regular work hours, evenings, and weekends. Retail clinics provide services for minor health needs. They do not provide care for medical emergencies or urgent health needs, such as fractures or large lacerations. At a retail clinic, patients are seen by a nurse practitioner or a physician assistant, who are certified to treat non-life-threatening illnesses and injuries. They provide convenient, high-quality care at reasonable prices.
Retail clinics are a cost-effective way of receiving immediate care for non-emergency medical issues. These retail clinics usually don’t have x-ray machines and other diagnostic equipment; nor do they offer services for urgent or life-threatening issues. They typically charge a flat fee for a particular service. Therefore, going to a retail clinic can help control medical care costs.
Benefits of Retail Walk-In Clinics
Retail walk-in clinics have the benefits of high-quality and cost-effective healthcare services. Most retail clinics offer the following services:
Treatment for minor illnesses, injuries, and skin conditions;
Screenings and monitoring;
Travel health;
Wellness and physicals;
Women’s health;
Blood pressure monitoring;
Cholesterol checking; and
Vaccinations.
Other advantages include the following features (Note: The author covers CVS offerings, but these advantages also extend to other retail clinics such as Walmart, Concentra, Wellcare, and others):
Convenient locations: For example, MinuteClinic has over 1100 locations in 35 states. Most of these clinics are inside a CVS pharmacy.
Extended hours of operation: MinuteClinic locations are open beyond regular business hours, seven days a week.
Professional staff: MinuteClinic uses certified nurse practitioners (NPs) and physician assistants (Pas). They provide convenient, high-quality care at reasonable prices.
Integration with major health systems: MinuteClinic connects with the traditional healthcare system in various ways. This includes partnerships with nearly 70 major health systems. This lets care providers easily share summaries and other health information with physicians and health institutions. As a result, these clinics provide continuity of care and allow follow-up with traditional care in the physician’s office.
Telehealth visits: MinuteClinic offers telehealth visits for remote access to healthcare services. With telehealth, MinuteClinic providers can address the patient’s health needs from the comfort of home or even when traveling. All telehealth options are also available with or without insurance.
The roughly 2700 health clinics located in chain pharmacies, supermarkets, and retail stores—up from 1200 in 2010 —are convenient for patients, because they require no appointment for a visit. Staffed mainly by PAs and NPs, they typically are open seven days a week. They have become a common source of care for nearly a quarter of Americans with no primary care doctor.(10)
”Walk-in” is a bit of a misleading term. Both retail and urgent care facilities are “walk-in” or “no appointment needed.” Retail clinics fill the need for quick, less complex health needs that can be served outside the doctor’s office or urgent care facility. However, retail clinics generally offer lower treatment of less acute issues than urgent care clinics. Their services include treatment of uncomplicated illnesses, such as a sore throat or earache, or preventative care, such as vaccines or physical exams. In addition, retail clinics usually follow a clinic-within-a-store model with limited space.
Prices and copays for treatments typically are lower than those for an urgent care visit. Retail clinics also have the advantage of price transparency, because fees are posted on their website or in brochures available upon check-in. This is a boon for patients who often receive sticker shock when they go to the physician’s office and receive a bill where the cost of care needs to be explained to the patient before receiving medical services.
New Trends in Retail Clinics
What’s new is that CVS and several other retailers are expanding their services. CVS, for example, is planning 1500 HealthHubs, where consumers can get nutrition counseling, attend wellness classes, receive medication reviews to reduce polypharmacy, and help manage chronic conditions, such as type 2 diabetes and high blood pressure, as well as vaccines and treatment for problems such as colds and the flu.
Several other retailers also have begun to offer additional services. Walmart offers patients the choice of seeing the same PA or NP at each visit so that the patient can develop a relationship with a provider. Walgreens is ramping up its options, too. In partnership with the VillageMD chain, the company recently opened a clinic near Houston, with plans to open more in the future.
For patients without insurance, there may be a menu of services for a flat fee. At Walmart Health centers, for example, patients can receive checkups for $30, office visits for $40, cholesterol tests for $10, sutures for minor lacerations for about $115, and dental and eye exams for $50. These retail clinics accept insurance, so patients may still have deductibles, copays, and coinsurance.
Conclusion
Retail clinics will be attractive to PCPs who want a practice compatible with a healthy lifestyle and a reduced risk of burnout. In the retail clinic setting, these PCPs can practice medicine without the burden of administrative obligations, which distract from providing patient care. Furthermore, specialists can market their services to these clinics and offer follow-up care. They can make themselves available for patient referrals. Finally, the concept will also benefit insurance companies: the reduced cost of care decreases their costs, because the retail clinics provide care at a lower price.
Bottom Line: Ultimately, the right choice for obtaining medical care varies from patient to patient. What’s best for a patient will depend on their financial situation, insurance coverage, and healthcare needs. Retail models quickly evolve based on opportunities to provide timely care at a reduced cost. Although healthcare delivery in retail clinics is gaining popularity, the delivery of comprehensive, well-coordinated, patient-focused care in these walk-in clinics will change the playing field for primary care delivery.
References
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