Strategic initiatives

Driving forces / Public policy / Strategic initiatives / Tactical innovation — No Comments
20
Aug 10

Policy May Shape Clinics – and Clinics May Shape Policy

This concise summary of the emerging retail clinics business:

McMedical Care |The rise of health clinics in retail stores could affect both health policy and regulation

http://www.governing.com/topics/health-human-services/McMedical-Care.html

was published in Governing in 2006, so it could not have been informed by the recent white paper on clinics and public policy released by Rand, & written by Dr. Ateev Mehrotra and colleagues which we posted about yesterday. We did not see it in 2006 – a link to the article showed up in our mail just yesterday – so we took heed of the serendipity & decided to reference it here.

At very least it makes a nice complement to that more recent publication, providing a historical point of reference for the early & modest research findings summarized in the Rand paper.

Clinic openings and closings / Driving forces / Lab tests and clinics / Retail clinics / Strategic initiatives / Walk-in clinics — No Comments
6
Jul 10

Emerging retail clinic models: Zoom, zoom

We’re somewhat embarrassed to say we’ve never heard of ZoomCare until last Thursday.

ZoomCare, a cluster of 4 (soon to be 6) clinics in & around Portland, Oregon, is a mixed-clinician (MDs and PAs) model that

  • has a clear, crisp, 6-point* value proposition,
  • is not Rx hosted, retailer-hosted, or hospital-hosted,
  • fills treatment-related scripts & does labs on-site in its clinics
  • does not focus on employed populations**, and
  • alludes to a plan to build out its own network of care providers beyond ZoomCare’s walls.

*ZoomCare’s homepage does indicate EIGHT things they would like you to know about them – but at least one of those extra items is a bit misleading. Number 8 says they offer “online help 7 days a week”, but that online help consists of enabling you to make an appointment for a conventional clinic visit during their regular business hours. Online scheduling can be very helpful – but there is no teleclinician availability for off-hours issues at ZoomCare.

** while ZoomCare makes no specific pitch to employers at its website, one of its testimonials suggests just the kind of thing the ZoomCare team would certainly not mind taking place all over Oregon….

….I just wanted to say again how much I appreciate the service that you are offering at ZoomCare. I will be sending an email to the president and the CEO of New Seasons Market (my employer) to let them know about you guys. I think that ZoomCare is exactly the thing the majority of our employees need in terms of health care. I hope that I can help you with some referrals….

Driving forces / Opinion/commentary/analysis / Physicians' perspective / Retail clinics: field reports / Strategic initiatives — No Comments
19
May 10

Docs Embracing The Convenient Care Concept

Judging, that is, from two items freshly available on the internet.

First this from a May 18 posting in Postgraduate Medicine: Embracing The Convenient Care Concept.

The five Drexel clinicians (three are physicians, at least one is a registered nurse) who authored this piece address the controversial status of retail clinics among physicians this way:

This new trend in delivering health care has been mostly, if not totally, ignored by the medical school practice plans, with the exception of the Mayo Clinic in Minnesota, which has developed several “express care” clinics as stand-alone facilities. As a medical school practice plan and a division of general internal medicine, we could continue to keep a blind eye toward this new trend in primary care medicine or embrace the concept. We aim to develop a new convenient care model integrating our College of Medicine practice plan in partnership with our College of Nursing graduate nursing program to form a stand-alone clinic within a bustling business district in downtown Philadelphia….

….Although organizations such as the American Medical Association and the American Academy of Pediatrics initially voiced concerns over quality of care and disruption to the continuity of care, … retail clinics have exceeded expectations and proved that they can perform well, both in terms of patient satisfaction and in quality measures….

The second is a Washington Post guest editorial written by San Francisco-based emergency room physician Jennifer Brokaw:

Keeping routine medical care out of hospital emergency rooms (5/18/10; free registration may be required).

….[N]on-emergency care delivered in the ER costs almost five times more than in a doctor’s office or clinic.

There are four ways we can steer minor emergencies away from the ER.

First, establish more offices and clinics that are not based in hospitals (and do not carry hospital overhead). The recent trend toward low-cost, retail- and pharmacy-based clinics has been a relative success for what these facilities offer: quick evaluation and treatment for simple problems. They have been found to cost less than one-fifth of what an ER costs for the same complaint….

Clinics in pictures / Strategic initiatives / Tactical innovation — Comments Off
5
May 10

Thinking Outside – and Inside, and All About – The Box

Yes, we know this initiative is not specifically about retail clinics, or US-style convenient care, but we just think that it’s incredibleness quotient is off the chain:

Containers Into Clinics

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4
May 10

Where Do Doctors Learn The Price of Care?

Turns out more than a handful have become well-acquainted with the role of cost in clinical decisions at the East Harlem Health Outreach Partnership, which is a free (for patients) clinic run by students of Mount Sinai School of Medicine, according to this 5/3/10 New York Times story: Teaching Physicians The Price of Care (5/3/10.

Medical students evaluate patients, choose which drugs are prescribed, arrange care for patients who need to see a surgeon or other specialist and collaborate with a social worker to help those who need social services or assistance paying for medicine. They also sit on the steering committee and are in charge of researching and updating the clinic’s formulary, a stock of inexpensive, cost-effective drugs that are purchased from the hospital pharmacy.

Surely similar models might emerge for providing teaching hospitals’ students about real world health costs via immersion in hospital-supported clinic operations…?

Driving forces / Health care practitioners / Opinion/commentary/analysis / Physicians' perspective / Strategic initiatives — 1 Comment
29
Apr 10

Primary Care Busy-ness: NEJM Article Has Major Media Hotness

So Dr. Richard Baron’s What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice shows up in the Occasional Notes section of the New England Journal of Medicine on 4/27/10, and the watchful editors at the New York Times and USA Today are already busily turning it into News Of More Than Occasional Note.

And rightly so.

So what’s being said?

The NY Times’ Steve Lohr, a health journalist who “gets it”, doesn’t seem to get this one – at least not in his opening lines:

A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system.

Really Steve? The thrust of the piece is that doctors need to be paid differently? Or is it rather that they have to practice differently, so there is justification for paying them differently?

You can probably guess what we think, but here’s a passage directly from Dr. Baron’s post that bolsters our confidence in thinking so (with our emphasis):

The work we describe arises from the needs of patients in a society that assigns many roles to physicians — from making diagnoses and providing treatment to ordering tests and filling out forms — and the practice must be organized to respond reliably. How and by whom the work is done is a continuing project of primary care redesign, dependent on both the skills of available nonphysician staff and the extent of information-technology support.

Meanwhile, correspondent Lohr only gets to this concept indirectly, at the very end of his brief report, and then thanks to a quote from Obama administration HIT point man Dr. David Blumenthal (again, we’ve provided the emphasis):

….Dr. Blumenthal said the study showed “the enormous strain” on family doctors, but also “a pathway toward escaping at least some of those burdens: the electronic health record combined with changes in workflow and payment.”

USA Today’s Rita Rubin gives greater emphasis to the “what are primary care doctors actually doing?” aspect of the story – taking it less for granted that what primary care doctors are doing is what everyone thinks they’re doing, and what they ought to be doing – but she still does not delve into the trickier, thornier, more sensitive matter: what if, once what’s going on there is fully sorted out, everyone discovers that other health care practitioners are better situated to do some of those things, in league with a “re-purposed” contemporary primary care physician?

Now there you would have a platform for disruptive innovation.

EXTRA CREDIT: It may seem unrelated at first, but we feel The Data-Driven Life (New York Times, 4/26/10) supplies valuable commentary on the vital issue of applying data to the information-driven business of deciding “what am I doing, is it what I fully intend to be doing, and what might I do differently to do what I intend to do better?”

Clinics in pictures / Driving forces / Employers and retail clinics / Health care practitioners / Public policy / Retail clinics: field reports / Strategic initiatives / Tactical innovation — 1 Comment
29
Apr 10

Community Health Centers and Retail Clinics: Are You Thinking What I’m Thinking?

I mean, when I look at the map of community health center locations provided in this New England Journal of Medicine article: (Health Care Reform and Primary Care — The Growing Importance of the Community Health Center, 4/28/10), I say to myself “imagine if that many locations were served by retail clinics”.

And then I occasionally reply to myself, “well, why couldn’t the retail clinic operators do for some – and maybe many – community health centers what they have begun to do for employer-sponsored onsite clinics?” which is namely to supply operating expertise with special attention to the particular needs of the location’s clientele.

And then I frequently go “hmmmm….”

For the time-pressed, here is the map in question – though I strongly urge anyone following retail clinics to check out the entire article:

Nationwide Distribution of Community Health Center Sites, 2008.</p> <p>Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010

Nationwide Distribution of Community Health Center Sites, 2008.
Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010.

The accompanying map of the share of each state’s population that frequents CHCs is also information-rich:

Percentage of the Population of Each State Served by Community Health Centers, 2008

Percentage of the Population of Each State Served by Community Health Centers, 2008

Driving forces / Retail clinics: field reports / Strategic initiatives / Tactical innovation — Comments Off
28
Apr 10

Initiatives to Reduce Avoidable ER Visits Dept.

No, we don’t have “departments”, a la old-timey print periodicals, but we’ll probably strive to keep an eye out for stories similar to this unprepossessing notice that appeared in the 4/28/10 Chillicothe Gazette:

New Initiative Designed to Reduce ER Visits

A kickoff meeting for IMPROVE (Implementing Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department) is scheduled for this morning in Columbus….

According to the very brief article, the program will

  • redirect ER visits to more appropriate treatment venues
  • increase communication quality among care providers and health care systems
  • promote ER visit alternatives “consistent with the medical home concept”

to accomplish its mission.

Big goals, short article, no publicly available details we know of, yet. Looking forward to learning more about it.

Driving forces / Opinion/commentary/analysis / Retail clinics / Retail clinics: field reports / Strategic initiatives / Tactical innovation — 1 Comment
26
Apr 10

Q&A With MinuteClinic’s Sussman on Providing Chronic Care

Just when we were all set to mope about the shortage of new retail clinics stuff to kibitz about, along comes Drew Weilage’s Our Own System blog with a sharp note regarding the Minneapolis Star Tribune’s Q&A with MinuteClinic CEO Andrew Sussman on MinuteClinic’s new chronic condition monitoring services (Minneapolis Star-Tribune, 4/18/10). The Star-Tribune’s Chen May Yee is atop her formidable reportorial game with this question (though the reply is not particularly revealing):

Q I’m intrigued by the lineup of MinuteClinic CEOs so far. You had Michael Howe, who came from the fast-food world, followed by Chip Phillips, who came from the pharmacy world, and now you, a doctor who comes squarely from the traditional health care world. What does this say about MinuteClinic’s ambitions?

A I come with great excitement for delivering health care services in new ways that meet patients’ needs, that’s accessible, affordable. Right now, that’s what our country needs.

We like both Weilage’s reference to the Star-Tribune’s article (how do we miss so many of these gems ourself? All those geeky alert and monitor code thingamabobs, for naught!), and also Weilage’s blog, from its minimalist design to its optimalist content. Good stuff, that.

PS: here’s another terrif piece, introduced to us in the same Our Own System article, on nurse-centric programs crafted to manage hospital readmissions more effectively (or, more accurately, to avoid them)

Dr. Ateev Mehrotra / Driving forces / Health care practitioners / Opinion/commentary/analysis / Physicians' perspective / Retail clinics / Strategic initiatives — Comments Off
9
Apr 10

Is Physician Resistance a Real Barrier to Retail Clinics’ Success?

A 4/8/10 story by Healthleaders Media‘s Cheryl Clark asks the timely question Will Retail Clinics Be a Key Player in Post-Health Reform World? – then proceeds to address a quite different, though related, question.

That question is, how ‘real’ is physician resistance to the growth of retail clinics?

On cursory examination, the positions taken by physician organizations seem real. The Healthleaders Media article notes the AMA’s recommendation that store-based clinics have “appropriate physician oversight on-site”. The California Medical Association offers 3 reasons why retail clinics are not in patients’ best interest, which can be summarized as 1) retail clinicians do not have the requisite competence 2) they aren’t built to share care information with the patient’s primary care doctor 3) their primary purpose is to sell “beef jerky and Gatorade”, not health care, in the words of the CMA’s CEO that the article quotes.

We can leave questions of clinical purpose & competence to more authoritative analysts like RAND’s Dr. Ateev Mehrotra, whose research to date has largely refuted the essentially unsubstantiated assertions of the physician organizations. What we CAN do is ask whether the AMA, the CMA, and their kindred clinician associations are prepared to deal with the issue as people of science rather than politics – that is, to weigh their concerns on the scales of data, of evidence, rather than resort primarily to dismissive remarks in press releases?

Frankly, we do not see how the physician organizations CAN take the high road here, even if they want to, because the data they have, that they can access and evaluate, is simply not likely to be as good – as timely, as auditable, as thorough – as the data and analyses that retail clinics can deliver. In support of their position, physician groups have anecdotes, rather than evidence. Until they have evidence, it is difficult to understand how their resistance can be regarded as a “real” barrier to retail clinics growth.

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