31
Jan 12

Prevention Online: Retail Clinics ‘Trending’

It’s a big deal when a magazine having the vast circulation Prevention enjoys runs an article on retail clinics. We feel reporter Holly Corbett did a nice job on this recent general interest piece: The Rise of Health Clinics Inside Retailers (Holly C. Corbett, Prevention Magazine online, January 2012)

At the same time, we did find this quote from Prevention Advisory Board member Jennifer Reinhold (B.A., Pharm.D., BCPS, assistant professor of clinical pharmacy at the University of the Sciences in Philadelphia) a little bit curious (we added the italics):

“The interesting thing about these clinics is that the majority are run by nurse practitioners rather than pharmacists, and the pharmacies are often separate entities because most, such as CVS, don’t run the companies that own the in-store clinics,” says Reinhold.

Two things:

  • We know of NO retail clinics that are run by pharmacists;
  • and

  • MinuteClinic IS wholly owned by CVS – so our feeling is that Reinhold’s assertion is a distinction without a difference.

26
Jan 12

Meditation on a Clinic Locations Search Tool

We’ve linked you to a screencap of a health care facilities search tool in action, not to point fingers at the creator of that application – which by some accounts is very popular – but to use it as a point of departure for talking about why doing easy things can be hard sometimes. We LIKE that we are at the stage where we can consider what kinds of clinics location strategies and executions make the most sense – that we are BEYOND the stage where people are undecided WHETHER such capabilities make sense in the first place. We’re making progress, and our progress is toward making “easy” and convenient things TRULY easy and convenient. Finally, note that a) elements of our praise and/or criticism may apply to other clinics locators, including our own; and b) our observations are basically preliminary jottings – deadline pressures and all that, y’know…. Your own comments, suggestions, observations & corrections are welcome.

One of the chief difficulties of doing easy things is that they can seem so easy that aspects of accomplishing them are taken for granted. In the case of clinics search, the activity seems mind-numbingly obvious in almost every respect: “hey, you just search for, y’know, clinics, and you get results, and you get up and go to one. Doesn’t Google do this already?”

No, Google doesn’t do this already. In fact, it may be getting worse at it (we hope to write more on why that is true someday. For now, take our word for it).

There’s no “required” start point for clinics search, but it can be helpful to consider the user, and make some educated design guesses to begin with.

So:

  • People looking for clinics have an immediate but not an emergency need to know where they are. They aren’t gushing blood, but they do have a troubling throbbing, ringing, burning, itching, etc., that they want to have addressed quite soon, and with minimal complication.

    This means they want to know where clinics are nearby, and quickly.

  • They’re likely to have a general feel for their local area – if you tell them the name of a nearby town they probably know it. And according to the latest research from Rand and Dr. Ateev Mehrotra, people looking for clinic care tend to be from where they’re looking.
  • Merely showing someone that a clinic exists, within a particular number of “as the crow flies” miles gives them no “feel” for the clinic’s proximity in their local context.
  • They don’t want to have to scroll through long lists of clinics, they don’t need a huge variety of search/sort options, and they may not be able to move back & forth across multiple screens of information on the gadget they’re searching from. Dealing with lots of pick lists, dropdown menus, and graphics-heavy controls on cellphones is no fun. A person searching for clinics needs to be looking at details about a nearby clinic in seconds.
  • They’ll want to be able to access clinics information from a smartphone. More & more people have them, and quite often the need for routine non-urgent care happens when a notebook or other “less mobile” computer is unavailable. Again, keeping a user’s control options very simple is critical. Multiple boxes to check, picklists to peruse, options to manipulate, are obstacles, rather than benefits, to the typical user.

So what does the application depicted do well, and not so well?

Good

  • it sorts results by distance from the search location by default. This is better than sorting them alphabetically, which some of the clinic operators’ own search tools do. Ideally, the application would pick up search location information from the user’s location – particularly when the person is searching from a “real” mobile device, like a cellphone – and automatically arrange the sort in that fashion – but no one is doing this at present that we’re aware of.
  • Ability to sort by distance, or by featured clinics – we like this feature, but feel it should only be displayed once a list – by distance – is generated. Focus on what the user’s need is first.

Not So Good

  • No names of the places where listed clinics are: The town where a clinic is is displayed once you click through a listing, but until then you only have a clinic’s name and it’s distance from the place entered for the search (presumably a “zip code center” or other lat/long centering convention). Why be so opaque about where listed clinics are? It’s confusing, and requires extra steps – unless the 1st choice happens to suit the user’s purposes, s/he has to go back and forth from the list to detail.
  • Too many distracting search options: why distinguish searches by retail and urgent care clinics? Why not simply indicate in the list results what sort of clinic the location is?

Clicking through to a specific clinic’s information, we find – important things missing, and/or confusing.

  • There is no information on the clinic’s operating hours. None. That’s…bad. Really inconvenient. Really unhelpful. Really lazy (it’s publicly available for most clinics, for goodness sake).
  • The application helpfully lists “additional” clinics “in” the town where the specific clinic we’ve drilled down to is based – but of course many if not most of these additional clinics are not IN the town, and the individual listings do not display any town or city information, so…. another confusing & frustrating oversight. You HAVE that data – why not deploy it more helpfully?


17
Jan 12

TakeCare Health Introduces Appointment Scheduling

We’ve written about the pros & cons of appointment scheduling less than we would have guessed. One of our most recent entries on the subject was posted all the way back in January 2011, and didn’t technically have anything to do with retail clinics.

Target is alone among the “name” retail clinic operators to try appointment scheduling – and it abandoned the practice quite some time ago. ZoomCare, a clinics operator in Oregon and Washington, does offer appointment scheduling (and we feel does it the best).

That’s why we’re intrigued that TakeCare Health has decided to give scheduling a go (TakeCare Clinics Now Offering Real-Time Appointment Scheduling Option, 1/17/12 Drug Store News).

Walgreens’ Take Care Health Systems, which operates more than 350 clinics inside select Walgreens locations across the country, has announced that patients now can schedule appointments online or in the clinic.

Here’s a link to TakeCare’s new appointment scheduler (curiously, not provided in their media release).

We have to say, we like its design. You pick the reason for your visit from a list of options, select your clinic – or, even more conveniently, your location, and distance you’re prepared to travel – and the general time of day you’d like an appointment. Press enter and you’re presented the open visit times for any location within your selected travel distance.

Things we’re unclear about: Does the scheduler play nice with iPhone and/or other smartphone devices? We didn’t/couldn’t test that critically important capability. Close to one-third of visitors to our homely clinics locator are visiting from smartphones these days; we would guess the share is greater for actual retail clinics operators. Our untested concern is that TakeCare’s application seems like it would require a smartphone visitor to move through more steps than smartphone app users will typically endure patiently. We hope we are incorrect about that.

Things we’re less keen about: when we first visited Take Care’s site, we selected a clinic location to see its available appointment times. It was lunchtime at the clinic we selected but the display informed us only that the location was “Closed”. Not “Closed for lunch until [X time]” – just “Closed”. Psst, TakeCare: we’d advise you not to provoke your would-be visitors to assume the location has shuttered its doors & windows, for the day or maybe forever. Be specific about what “Closed” means.

In sum, TakeCare’s appointment scheduling tool isn’t quite as easy to use as ZoomCare’s – but it’s not at all shabby.

What do you think? Is retail clinic scheduling a feature worth featuring for clinics operators?


11
Jan 12

RIGHT Is What, With THIS MinuteClinic Picture

Recently we voiced our confusion about the expression of retail clinics – and specifically MinuteClinic’s – value proposition found in a slide deck presented by MinuteClinic CEO Andrew Sussman to a clutch of investors last December 20th. The slide that provoked our concern was this one:

Do Retail Clinics Provide Care of Quality Comparable to ERs, MDs, etc?

Our feeling was that the offending slide did not put MinuteClinic’s best foot forward far enough. We expressed hope that the message conveyed was fully as positive as the chart’s graphics depicted.

Our hopes were answered!

We were contacted by MinuteClinic media relations executive Brent Burkhart, who explained the technical hangup that pushed MinuteClinic’s PowerPoint lamp under a bushel, and who helpfully provided a new, much improved version of the slide – which we share with you here:

Retail Clinics Provide Quality Care at superior prices to ERs, Urgent Care Centers, etc

Now THAT’s making one important facet of the retail clinic value proposition quite clear indeed!

Bonus for our readers: link to the updated presentation deck

Many thanks, Brent!


03
Jan 12

Retail Clinics in the US: “Few Other Viable Alternatives…”

Euromonitor International has issued a nice summary of retail clinics’ emergence, from a European perspective (Adding a Checkup to Your Shopping List: The Emergence of Retail Clinics, Euromonitor International, 12/28/11).

The story contains several useful info-nuggets; for example,

…the first [UK health] centre in a retail location only opened in 2008. While the NHS made an earlier attempt to provide patients with more convenient care access, opening six commuter walk-in centres near railway stations between 2005 and 2007, it closed the last of these centres in November 2011. Canada, Kenya, and other countries have also only started experimenting with retail models of care within the past five to ten years.

Of course, OTHER nuggets may cause readers to doubt the caliber of EI’s reporting:

Cost [as a driver of retail clinic use] is particularly compelling in the US, which leads the world by far in health expenditures, topping 23% of GDP in 2010 according to Euromonitor International data

“topping 23% of GDP”? Really? CMS data suggest Euromonitor’s data on US health care expenditure as a percentage of GDP is close to 40% (6 percentage points) too high. Hmmm….

Happily, more good stuff on the emergence of retail health concepts in other parts of the world follows. For example:

Healthpoint Services is a for-profit company in India built on the premise of providing clean water and health care services in rural or remote areas. Its “tele-medical centres” offer consultations with doctors and other health care workers via video conferencing, on-site diagnostic tests, and access to a licensed pharmacist. Both prescription and over-the-counter (OTC) drugs are sold at large discounts, up to 50%. There are currently centres in several districts in India, but Healthpoint has plans to open pilot clinics in the Philippines and Mexico in 2012.

The [non-profit] HealthStore Foundation follows a similar concept in Kenya….[R]etail clinic franchises also operate in Ghana, Uganda, Myanmar, Pakistan, and other countries.

The chair of Healthcare Services Global’s board is Athenahealth COO Ed Park; Procter & Gamble is a prominent collaborator with Healthcare Services India.


03
Jan 12

What’s Wrong With This MinuteClinic Picture?

We’re picking on them because we’re fans – but something’s missing from the “Cost Per Episode” portion of this chart from a December 20, 2011 investor presentation by MinuteClinic President Andrew Sussman:

Do Retail Clinics Provide Care of Quality Comparable to ERs, MDs, etc?

We just think the dollar distinction amongst venues is more significant – and more favorable to retail clinics – than the chart, as presented, suggests.

To be fair, there are several interesting slides in the full presentation deck. We especially liked slide #10, which covers a growth projection for the non-acute treatment share of MinuteClinic visits. Doctors, are you watching…?

We also liked the socko finish of Sarah Kliff’s post at Ezra Klein’s WonkBlog, in which this information originally appeared last Tuesday (our emphases):

….CVS-Caremark’s stock surged last Tuesday afternoon in the hours after this presentation. Retail clinics aren’t the health-care system we’re used to — but when what we’re used to are long wait times and expensive care, that could be a welcome change.


29
Dec 11

Health Care ATM (Another Testable Model)

Don’t get us wrong – we luuuvvvvv primary care innovators, especially those who have so clearly sweated the details as have the executives at HealthSpot.

HealthSpot Segment from Dublin, Ohio, USA on Vimeo.

But we’re not particularly excited about their notion that their kiosks will supplant, rather than complement or substitute for retail health care:

[HealthSpot CEO Steve] Cashman said HealthSpot’s kiosks will provide a better experience than retail clinics because patients will have appointments with doctors rather than nurses, and offer an enhanced continuum of care by allowing a patient to visit with the same doctor for each appointment. In theory, a patients could visit with their own primary care physicians, assuming that the physician had signed up to be a HealthSpot provider.

Unless HealthSpot manages to successfully clone the physicians it envisages employing HealthSpot kiosks, their retail clinics replacement strategy faces a significant staffing challenge. Some MDs may indeed want to fill portions of their schedule with HealthSpot treatment opportunities. Some, unfortunately, will also see rendering kiosk treatments as cannibalizing their own over-scheduled, revenue-challenged practices.

Still, it’s hard to discount the caliber of vetting HealthSpot’s concept has undoubtedly received, judging solely from its list of executives, board members and investors (Cardinal Health).

HealthSpot’s kiosks are an admirable execution of non-emergency retail health treatment. They have a role to play in the transformation of primary care. The open question is how large that role may be.


23
Dec 11

Times-Fables: ER Wait Times?

Critics: Emergency Department Wait Time Claims Unsubstantiated (Karen M. Cheung, FierceHealthcare, 12/22/11)

Elizabeth Dudek, head of Florida’s Agency Health Care Administration, said she does not know of any studies that back up the marketing claims….

Commissioner Dudek pointed out that her department has not received any complaints regarding the accuracy of wait times posted on billboards. Perhaps this means few are paying them any attention.

Short ER Wait Times? Billboards Tout Hospitals’ Claims (John Dorschner, Miami Herald, 12/21/11)

Baptist Health South Florida recently launched some ER billboards, but it prefers to report wait times on a smart-phone app. Baptist spokeswoman Christine Kotler says Baptist aims to provide “genuine wait times,” measured in 30-minute increments for urgent care centers and one-hour increments for ERs.HCA also pushes its ER wait times, using text messages, hospital websites or on HCA East Florida’s Facebook page. “We want to leverage all the portals,” says HCA spokeswoman Nicole Baxter.


20
Dec 11

Aetna Acquires iTriage

We’re fans of developments in mobile health.

We know firsthand that the geography of “where is care?” plays a key role in health care, and that making it easier for people to find appropriate care for conditions they’re dealing with is a good thing.

We’ve watched iTriage – or more accurately, its media releases (example here), and partnership announcements – over the past several months, and have not gotten it.

We get Aetna’s purchase of iTriage, “for an undisclosed amount” even less. While the acquisition media release talks about , iTriage’s primary clients have been hospital systems, and a significant focus has been promoting ER usage, through features like information about ER wait times. As anyone who’s spent more than a half-hour perusing info about health care knows, emergency rooms are one of the most expensive places to obtain health care for conditions that do not happen to rise to the level of an emergency. People using their cellphones to scrounge around for a suitable treatment location are not, in the main, contending with conditions that rise to the level of an emergency. Driving more patient volume to ERs – particularly ERs of hospitals who’s spent a bale of dough upgrading their ER facilities – may be going where the money is, but few can make a defensible case that that’s where the health value is.

This picture of iTriage site visits doesn’t help us get iTriage:

On the other hand, maybe information of the type depicted in that chart helped Aetna get it – for whatever it’s worth.


16
Dec 11

In Houston The Doctor Can’t See You Now (and Apparently Neither Can the PA, Frequently)

Carrie Feibel adroitly documented the increasing difficulty Houstonians have scheduling prompt doctor visits in this recent NPR piece(In Houston, The Doctor Can’t See You Now,Carrie Feibel, KUHF Houston, 12/8/11), but we wish she had noted that Texas physician oversight regulations, while loosened a bit in 2009, are still among the country’s most stringent (The Texas Coalition for Nurses in Advanced Practice did a nice job of summarizing the 2009 regulatory amendment’s effect here. CNAP summed up the limited impact of the law in this sentence: “For most APNs prescribing in primary practice sites, medically underserved sites and hospitals, [the amendment] will not change anything about the physician supervision required in their sites.”). It seems almost like nitpicking to observe that the Texas regulations also happen to vary from place to place around the state. Hey, it’s a big state.

Could it be that Martin Luther King Jr. Health Center clinics director Dr Robert Trenschel’s concern that “the situation in Houston is likely to worsen in 2014, when the Affordable Care Act allows 32 million more people nationally to get subsidized health insurance or Medicaid coverage” is exacerbated by Texas’s physician oversight regulations?

Why yes – yes, it could.

But hey Texas (and USA) – your wait times are probably still better than in Sweden, Norway and Canada (thanks to Slate’s Aaron Carroll and Matthew Yglesias!)