Scott MacStravic, PhD
There are a number of reasons for hospitals to create and maintain working relationships with retail clinics, though at least one major reason to do so very carefully. Hospitals can gain patient referrals from such clinics, as well as revenue for physician oversight, for example. But with widespread primary physician opposition to or at least concerns about clinics staffed only by nurse practitioners and physician assistants, there will have to be care in obtaining their acquiescence or at least apathy toward the idea.
Hospitals already operate in the same “convenience sphere” as do retail clinics, though more often in the “urgent care clinic” category, where physicians are the major providers.
But recently, some hospitals and systems have signed formal relationships with non-physician-staffed clinics as well. Memorial Hermann Health System in Houston, for example, initially provided physician oversight for RediClinics in its market, but recently signed a full partnership with them, including quality and co-marketing initiatives. [“RediClinic Announces Fifty-Fifty Partnership with Memorial Hermann” RediClinic.com Apr 11, 2007.]
As it moves toward a planned 500 or more locations, RediClinic is also partnering with Bon Secours Health System, which will offer physician oversight for clinic sites in the Richmond, VA area. [“Rediclinics Debut in Richmond Inside Wal-Mart Supercenters with Bon Secours Partnership” RediClinic.com Mar 29, 2007] It joins both Revolution Health and Wal-Mart as “partners” in some way with the RediClinic system. (I would like to think that I had some influence on this development, since I advised Bon Secours to join in the “placeless healthcare” movement in 2005 during a consulting engagement therewith.)
Meanwhile, retail clinics, particularly RediClinics, are moving more in the wellness direction. This adds an enormously larger market to their potential than does routine sickness care. Wellness has already been described as coming $1 trillion market, to reach that level somewhere between 2010 and 2020. After all, practically everyone in the US has some chronic condition, health risk or concern that could benefit from wellness support, and retail clinics are becoming ubiquitous.
Of course, retail clinics that succeed in reducing patients’ incidence and prevalence of disease may be viewed as the enemy, rather than potential partners, by hospitals that are wholly dependent on sickness care revenue. But an increasing number of hospitals are offering wellness programs of their own, for their employees at least, and often for local employers, as well, given how profitable this type of service can be. Northwestern Memorial Wellness Institute in Chicago is one fo the more recent examples.
The MDVIP high-end retainer medical practices have already demonstrated how much effective proactive patient health management can be in reducing sickness care use. MDVIP Patients in eight states for which comparative hospitalization rates are reported had rates from 36.0% to 92.7% lower than the top rated insurance plan in each state. Medicare patients had rates from 2.7% to 93.5% lower in four states for which comparative rates were reported. (www.mdvip.com)
How much affect retail clinics will have compared to MDVIP practices, which see far fewer patients than traditional practices (a maximum of 600) and cost much more than retail clinics charge is unknown, but their effects will surely be in the same direction. As such, they may find new sources of revenue of their own, by offering services to employers directly, rather than to consumers only. Pharmacists have already proven their ability to reduce sickness care use in diabetes disease management programs such as those in Asheville, SC, so with so many retail clinics in pharmacies or superstores that have pharmacies, the potential for this proactive health service is also increasing.
In any case, hospitals should at least be aware of what retail clinics in their markets are doing, and consider carefully what kinds of relationships with them might be mutually beneficial. As the number of such clinics increases from the current few hundreds to many thousands, they will be impossible to ignore.
