Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

A CVS Retail Clinic at the corner of a street.

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

This kind of convenience is definitely a plus. But what is even more interesting to us at the Robert Wood Johnson Foundation (RWJF) is the potential role retail clinics can play in our larger vision of building a Culture of Health. Since 2006, the number of retail clinic sites has increased almost 900 percent from 200 to 1,800, and in 2012 they recorded some 10.5 million patient visits. A new study, “The Value Proposition of Retail Clinics” prepared by health care consultant Manatt Health with funding from RWJF, finds that retail clinics that are embedded in high-volume retailers, large groceries, and big chain pharmacies can potentially serve tens of millions of people each week.

The study identified key steps these clinics can make—and in some cases, already have—that can connect patients to health, wellness, and social services that promote public health in the broadest sense. To start, they can forge stronger connections with larger health systems. Ideally, after my husband visited the CVS clinic, information would have been entered into his electronic health record (EHR) and shared with his primary care physician. That rarely happens now, mostly due to poor connectivity between disparate EHR systems. Still, the Manatt study identified more than 100 such partnerships, including one that links the UCLA health system with the MinuteClinic chain of clinics operated by CVS. When a patient under the care of a UCLA primary care physician is seen at a MinuteClinic, the UCLA doctor automatically obtains a copy of the patient’s encounter and it is incorporated directly into UCLA’s EHR system. The plan is to make this flow of information two-way in the near future: UCLA patients will be able to obtain follow-up visits at a MinuteClinic as well as referrals to emergency and urgent care instead of having to make an appointment at their primary care physician’s office.

This table shows the Value Proposition of Retail Clinics. The six largest retail clinics sponsors represent 93 percent of the total number of clinic sites nationwide.

Retail clinics can also be used to connect people to healthy foods, products, and services. Imagine a diabetic visiting a retail clinic for a routine checkup and being prescribed a personalized list of groceries, pharmaceuticals, and medical supplies that can be picked up in the store. The Manatt authors describe just such collaboration between Texas-based RediClinic and H-E-B grocery stores on a 10-week, medically supervised weight management program. The clinic provides patients with physicals and nutrition programs tailored for diabetes, hypertension, and other restricted diets, as well as pedometers and exercise routines. It also gives patients grocery lists, directing them toward healthy food purchases within the store. Patients following the program lost an average of one to two pounds per week, while patients diagnosed as hypertensive decreased their blood pressure readings by 62 percent.

There are encouraging signs that retail clinics can move even further in promoting a healthier culture given the enormous customer volume in their host locations. Walmart alone serves more than 140 million customers each week. Its stores could be used to link lower-income people to a range of programs that address underlying social determinants of health, such as food security and safe and affordable housing.

As an example, look at San Antonio where H-E-B is collaborating with the Texas Health and Human Services Commission to place food bank workers in select stores to enroll eligible customers in SNAP, the federal food stamp program. These food bank workers help approximately 1,500 people each month apply for federal assistance.

The Manatt study makes it clear that retail clinics can be key players in the ongoing effort to create a higher-performing, more equitable health care system, but it also suggests room for improvement. Right now most clinics are located in relatively well-to-do locations—including major cities and affluent suburbs—rather than in the underserved areas where they might be needed most. Assessments of the quality of care could also be better. Insurers and licensing agencies collect and often make public data on how large practices, individual doctors, hospitals and other health care providers perform on quality measures, but retail clinics have mostly avoided this kind of scrutiny. Collecting quality data would increase transparency and accountability, giving consumers and insurers better information to consider when choosing a clinic over another provider.

As more big-box retailers and pharmacy chains expand into health care, there is real potential for clinics to provide services well beyond a simple throat swab, prescription refill, or quick diagnosis of a child’s ear infection. By connecting with larger health systems; steering customers to healthy foods, medications and lifestyle changes; and providing access to food stamps, affordable housing and mental health services (to name a few), these “doc-in-a box” clinics can contribute in a real way to building a Culture of Health.

Tara Oakman

Tara Oakman, PhD, is a senior program officer at the Robert Wood Johnson Foundation focusing on strengthening vulnerable children and families and working to improve the value of national investments in health and health care. Read her full bio