Driving forces / Health care practitioners / Onsite clinics / Physicians' perspective / Public policy / Reports, white papers, studies, presentations / Retail clinics / Strategic initiatives / Tactical innovation — Comment
09
March 10

Macy’s Floats Recommendations for “Primary Care Expansion”

The newly released primary care advancement recommendations from the Josiah H Macy Foundation include a number of recommendations for further investment and action. While the 49 participants and the event leaders produced numerous recommendations concerning primary care organization, financing, education, and leadership worthy of closer inspection, we have quoted our favorites below:

  • ….state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery. [Conclusion I, Recommendation 2]

  • ….Invest in primary care health information technologies that support data sharing, quality improvement, patient engagement, and clinical care, with the aim of continuously improving the health and productivity of individuals and populations. [Conclusion I, Recommendation 4]

  • ….implement all-payor payment reforms that more appropriately recognize the value contributed by primary care through such mechanisms as global payments linked to patient complexity and accountability for the provision of healthcare services, including preventive services, care coordination across settings, chronic disease management, and 24/7 accessibility. [Conclusion I, Recommendation 5]

Can anyone help me square these proposals with AAFP’s turnabout with respect to its qualified support for retail clinics?

Tip of the cap to Healthleaders Media’s Janice Simmons for her story on the release of the JHMacy Foundation report.

Uncategorized — Comment
08
March 10

An Inconvenient Tension

We’ve noted elsewhere the heightening tension between primary care physicians and convenient care clinics and their clinicians, most of whom are Nurse Practitioners.

Now comes a story about the manifestation of that tension in the state of Kentucky:

Battle Brewing Over Nurse Practitioners

[The Kentucky Medical Association is] fighting proposed legislation that would lift some limits on the ability of nurse practitioners to prescribe medication and perform other, mostly routine tasks such as signing a child’s immunization certificate or certifying the need for employee sick leave.

The proposed changes are included in Senate Bill 75, which is pending in committee. A similar measure, House Bill 556, is scheduled for a hearing Thursday before the House Health and Welfare Committee.

A quick check of the Kentucky Legislature’s web page for the bill shows no sign of action last Thursday.

Driving forces / Onsite clinics / Retail clinics / Take Care Health — Comment
08
March 10

Onsite/Retail Intersection (Not?)

Workforce Management’s Jeremy Smerd on employers’ emerging approaches to integration of clinics – onsite and/or retail – to their health strategies. Good stuff:

Work-Site Clinics Gain Favor as Retail Sites Lag (February 2010; free registration required)

The wide presence of Take Care’s clinics among employers in New York shows how Walgreens has aggressively tapped into the growing market for work-site medical clinics as part of its effort to rebrand itself as a health and wellness company. Analysts say the move makes sense….

Retail clinics and work-site medical clinics are thought to be complementary, offering different services for different populations….

But growth in retail clinics has stagnated….

Walgreens, meanwhile, has been quick to focus on work-site clinics. In 2007, Walgreens bought Take Care Health Systems, then a retail-based clinic, and the next year acquired two of the largest work-site clinic companies in the country, CHD Meridian Healthcare and Whole Health Management….

For now, Take Care remains the largest company in the fast-growing market for work-site medical clinics. The percentage of employers providing on-site health clinics increased tenfold from 1 percent in 2008 to 10 percent in 2009….

Count us among those who think retail and worksite clinics are complementary – and see the end of this post for at least one management team that also appears to do so.

We’ve commented elsewhere on Brian Klepper’s February 2010 onsite clinics assessment checklist for Workforce Management, but wanted to include references to both under this topic title (Brian is quoted in the previously cited Workforce Management article). Because we’re here for you, dear reader.

Finally, we’re including this brief 3/1/10 Illinois Daily Herald report on Walgreens recent restructuring announcement (free registration may be required). The restructuring moves management of the pharmacy-benefits services business under Take Care Health founder Hal F. Rosenbluth, “along with workplace and retail clinics”. We’re not yet sure how, but we feel this may be relevant to the onsite/retail clinics strategy dynamic.

EDIT 3/8/10: o-kaaaayyyy, that last story is getting some real attention – here’s a link to Drug Store News’ account, with commentary: Integrating Health Solutions for Payers, Walgreens Unifies Pharmacy, Wellness, Led by Crawford (free registration may be required)

….At its essence, the restructuring is an attempt by Walgreens to integrate and bring to bear all of its more than 8,000 “points of care,” on behalf of employers, government and managed care….The result, according to [Walgreens CEO Greg] Wasson, will be “a unified offering to payers in the healthcare marketplace,” as well as “increased efficiencies across Walgreens’ pharmacy, health and wellness operations.

Driving forces / Health care practitioners / Workplace clinics — Comment
08
March 10

Clinic Evaluation: A 13-Step Program

Brian Klepper recently provided Workforce Management readers with a Gawande-like checklist for use in evaluating onsite clinic service providers (13 Questions to Ask On-Site Clinic Vendors, Workforce Management, February 2010; free registration may be required). Brian is both an effective healthcare executive and a thoughtful observer of health management trends, with a knack for guiding readers from concept to action.

He doesn’t disappoint with his 13-point evaluation plan. While it focuses specifically on onsite clinics, astute readers will find it helpful in weighing the role of retail clinics in their organization’s health strategies, too. For instance, his point #2 urges executives to probe how onsite clinicians interact with specialists, noting that facet of clinic practice may have a significant impact on a clinic sponsor’s overall health costs.

Clinics in pictures / Retail clinics: field reports — Comment
06
March 10

Retail Health: Sights & Sounds

Not a regular feature exactly, but an apt catch-all title for items that have found their way into our Saturday morning catch-up mail.

So:

WFLI TV News clip on a clinic opening in West Lafayette IN, 2/21/10:

A shot of a billboard for an affordable health screening at a Walgreens, presumably somewhere in the USA, from a 2/12/10 New York Times piece titled What is ‘Affordable’ Health Care?:

Shot of a bilboard for an affordable health screening at Walgreens

A five-minute Today Show clip that aired last September, NBC’s Dr. Nancy Snyderman at the helm, titled How Not To Get Sick. At the close, Dr. Snyderman offers a handful of tips regarding retail clinics, including this insightful one: “don’t go in sick” – that is, use clinics proactively, as simple wellness clinics, for optimum value.

A 90 second news spot on retail clinics that aired on Albuquerque NM’s KOAT-TV Action 7 News HealthBeat in November 2009 (just saying ‘Albuquerque’ makes us feel better):

http://www.youtube.com/watch?v=WX1tfZfS3p4

Clinic openings / Driving forces / RediClinic / Retail clinics / Retail clinics: field reports — Comment
02
March 10

RediClinic Will Add “Meaningful” Numbers of New Clinics

A 2/26/10 story in the Houston Business Journal quotes RediClinic CEO Web Golinkin declaring that the pioneering retail clinic operator is prepared to open “a meaningful number” of new clinics over the next few years now that it has overhauled its clinics strategy (Fast Medicine: Designed for Convenience, Retail Clinics are Gaining Popularity Among Patients. Two pages; registration may be required)

Golinkin goes on to predict a similar measure of growth for other clinics operators.

In the same piece, National Center for Policy Analysis senior fellow Devon Herrick says clinics’ positive impact on the access they provide people to effective clinical care will ultimately lead to greater use – and presumably some measure of retail clinic success.

The endorsement of NCPA, headed by “father of the Health Savings Account” John Goodman, is politically frought. For example, prominent evidence on retail clinics’ impact on access suggests to critics that expanded access may be experienced mostly by those with greater than average means (We feel the fact that the same evidence may be referenced positively by those who support retail clinics merely makes the issue more nuanced, both in policy and clinical terms, than it might appear to be on the surface).

Nonetheless, the organization has patiently and successfully marshaled evidence of the usefulness and popularity of health care innovations that can appeal to people on the rightward end of the political spectrum as well as to those in search of effective ways to reshape health care delivery and costs generally, and communicated the character of those innovations effectively.

Clinic openings / MinuteClinic / Retail clinics — Comment
02
March 10

Clinic opening video

Okay, the clinic actually opened last November – but it’s still news to plenty of people. Plus, it’s on teevee!

Driving forces / Retail clinics / Strategic initiatives / Urgent care clinics — Comment
01
March 10

Ripples from the ConvUrgentCare Strategy Symposium

No, we were not able to make Tom Charland’s January event. And it wasn’t because it was held in Minneapolis.

Really.

We wish we had been there. Tom is and has long been one of the industry’s strategy leaders, and from the summary reports emerging about the event, a very useful time was had by all. (Being equal opportunity non-conference attenders, we aren’t even at this week’s National Retail Clinics Summit in Philadelphia, and we like Philadelphia. We have no doubt that that event also will produce some interesting food for strategic thought, and we hope to glean some tidbits via teh trusty intertubes for you and ourselves).

But back to news of the ConvUrgentCare Symposium. We enjoyed this account, dated March 8 (free registration required) from American Medical News reporter Pamela Lewis Dolan. In it, she notes:

Attendees discussed theories about why the model wasn’t working as well as they’d hoped: the seasonality of the business, oversaturation and the difficulty attracting patients outside of those who shopped at the host stores….

…[A] retail clinic — normally a small operation staffed by a nurse practitioner — that is open 4,000 hours per year can break even with 8,000 patients [according to calculations shared with attendees by Mr. Charland]. Most primary care physicians would find that pace, two patients an hour, financially unsustainable….

The piece goes on to cite calculations based on existing clinic operators’ reported traffic volume to indicate that even the leaders have not yet achieved profitable levels of visitors. Operators are finding that, among many contributing factors, the challenges would-be patients face in simply finding clinic locations is prominent.

(Gee, where have we heard that before… ;-) )

So, basic barriers like host businesses’ prohibitions against outside signage for retail clinics obscures clinic availability: people don’t know they’re there, so they don’t go.

We suspect inability to find any nearby clinics, regardless of brand, via an easy-to-use, smartphone-friendly, web-based clinics locater also comes into play, except of course for those fortunate enough to have discovered healthcare311.com….

Sorry. We couldn’t help ourselves. We now resume your regularly scheduled commentary.

A possible contributing challenge the Dolan article does not mention as having been discussed is imbued in the Symposium’s very title. “ConvUrgent Care” (we like it, Tom!) signals an awareness of a different sort of “job to be done” for consumers by clinics in the attendees’ market space. (We’re fairly confident that job does not closely match the conception of CoxHealth’s David Taylor, whom the article quotes as saying “…we’re set up to feed the system” – meaning, presumably, CoxHealth’s hospital system.) Retail clinics need not necessarily be able to handle stitching patients up, or x-raying them, to succeed, but for the concept to succeed, the form factor may well need to be conceived as something broader than it is currently by both consumers and operators.

Was anyone from the Innosight Institute, the consultancy that is home to innovation authorities Clayton Christensen and Jason Hwang (both of The Innovator’s Prescription fame), in attendance in Minneapolis? Judging from the principals’ speaking schedule, it doesn’t look like it, but if either had been, we’re quite sure they would have been quick to suggest a revisiting of the “job to be done” by clinics for their target customers may be in order, to determine if the form factors now in use provide the best fit.

Driving forces / Physicians' perspective / Regulatory activity / Retail clinics / Strategic initiatives — Comment
27
February 10

AAFP Hardens Line On Retail Clinics

From the American Academy of Family Practitioners website: AAFP Board Revises Retail Clinic Policy (2/24/10: immediate access)

The AAFP Board of Directors has revised its official policy on retail health clinics to reflect the Academy’s opposition to a growing expansion of scope of services provided by many such clinics. In addition, the Academy has discontinued its practice of entering into formal agreements with retail health clinics that support the AAFP’s desired attributes….

….The four retail health organizations that still hold signed agreements — MinuteClinic, RediClinic, The Little Clinic and BellinHealth Fast Care — have been notified that those agreements will be terminated.

In a letter sent to those companies, the Academy said its decision was not intended to reflect negatively on any retail health clinic company. Rather, it was made after observing the evolution of the retail health clinic model into expanded service lines….

without a trace of irony, the AAFP story continues:

The Academy’s policy urges all retail clinics to abide by the list of desired attributes, which, in addition to a limited scope of clinical services, should include

  • evidence-based medicine,
  • a team-based approach,
  • a system of referrals to physician practices, and
  • electronic health records.

Just to take the easiest point to pick off, we’d like a buck for every percentage point by which the share of retail clinics with EHR in place, and used, exceeds the share of AAFP docs with EHR in place, and used. We’d surely be able to buy the house a couple of rounds – and AAFP doctors are leaders in EHR adoption amongst physicians generally.

What we smell in this policy announcement is the acrid odor of fear. Instead of figuring a way to amplify on retail clinics’ simple, fundamental capabilities -take something as basic as routine identifiers information – and using them to their advantage, the AAFP’s public service solution is, to paraphrase a line from onetime Presidential candidate Sen. John Kerry, to vote against retail clinics after they voted for them.

That kind of health care reform we don’t need.

Modern Healthcare’s Andis Robeznieks reported the story, too, on Thursday (2/25).

Clinic openings / Retail clinics / Retail clinics: field reports / Take Care Health / Walk-in clinics — Comment
21
February 10

Walgreens’ Duane Reade Acquisition: The Retail Clinics’ Take

Go to Healthcare 311 – use that handy link over to the right there – yes, that’s the one, right up top – and run a quick search for clinics within 25 miles of New York, NY.

Note the number of results.

Now run the same search for Chicago, IL (neighborhood of Walgreens HQ), or Orlando, FL, or Atlanta, GA.

Compare the results. (Thanks for playing, and no, this exercise was not specifically a plug for our free and industry-leading clinics search utility. Really. It wasn’t.)

Hmmm……

We would guess you’re asking yourself “Why so few retail clinics in NYC”? There are a bunch of possibilities, which we won’t go into here (if you have a favorite theory, please add a comment).

We have the distinct feeling, unsubstantiated by any formal announcements from Walgreens or TakeCare Health other than the news of WAG’s purchase of the NYC-based pharmacy chain, that there will be more, soon; and/or that the number NYC-based employers in TakeCare Employer Solutions growing book of corporate clients will rise in the near future.

Duane Reade, in the form of its collaboration with DR Walk-In Medical Care, is already the NYC retail clinics’ market leader. Its format uses physicians as the care providers, rather than RNs/PAs. Direct reference to DR Walk-In is hard to find at Duane Reade’s main site – not sure what that means about the organization’s commitment to the retail clinic concept; as we know, even the big clinics operators make finding their locations more difficult than it ought to be.

← Older Entries