A new report from the Robert Wood Johnson Foundation looks at retail clinics and their role in advancing health.
As a starting point, the report provides an overview of the current retail clinic landscape, including their history, growth, and the patients served. The first clinics opened in 2000 and had grown to about 1800 by 2014. By 2012 they were serving about 10.5 million patients, accounting for 2% of all primary care encounters in the U.S.
Almost all clinics now accept Medicare and commercial insurance, while 60% accept Medicaid. High income patients are double as likely to use a retail clinic than those with low incomes. Clinic location may be one reason why, since clinics are more often placed in urban/suburban higher income areas. Yet when compared to the general population, retail clinic patients are more likely to be uninsured or have no personal physician.
It’s no surprise that convenience, hours of operation, and the option of getting walk-in care without an appointment are key reasons patients give for using a retail clinic. Most patients visit for diagnosis and treatment of a new illness, followed by vaccinations and prescription renewals. However, retail clinics have been expanding into more comprehensive primary care and chronic care management.
Cost of care at a retail clinic is lower. One 2009 study cited in the report found a retail clinic visit priced at $110 compared to $166 at a physician office, $156 at an urgent care center, and $570 at an emergency department. It’s also possible that a retail clinic visit might add to overall costs if it complements rather than replaces a physician office visit.
Most retail clinics are owned by pharmacies or big box stores. These retailers may staff and control the clinic on their own or affiliate with a health system. The affiliation arrangements may involve co-branding, and division of operational responsibilities between the retailer and system vary. In some cases, the health system [or hospital or physician group] may lease the retail space and assume full responsibility for the clinic’s operation.
A significant part of the report highlights examples of how retail clinics can play a larger role in promoting the public health. For instance, a ShopRite grocery store plans to open in an underserved area of Baltimore. It will introduce fresh food choices, participate in food assistance programs, and feature a health clinic and pharmacy. In another case, Geisinger Health System launched Careworks Convenient Healthcare inside the supermarket chain Weis Markets. Geisinger and Careworks share an electronic health record system and coordinate care. It has resulted in fewer emergency departments visits and gained 3000 new patients that previously had no primary care physician.
The report makes these retail clinic optimization recommendations for advancing the nation’s culture of health:
- Integrate into the health delivery system
- Measure and report quality of care
- Improve access in underserved areas
- Provide services to young children
- Standardize scope of practice rules for nurse practitioners and physician assistants
- Require Medicare and other insurers to reimburse clinics for appropriate telehealth services
- Examine more expansive roles retail clinics can play in supporting public health and emergency response
- Make the business case to payers to broaden and bundle services
- Research the business case to expand the range of clinic services, such as assistance with insurance enrollment and program access to nutrition, housing and other services
Source: Bachrach D and others. Building a culture of health: the value proposition of retail clinics. Robert Wood Johnson Foundation; Manatt, April 2015. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf419415
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