How Can Retail Health Help Hospitals Meet Health Reform Goals?

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In 2011, there were 1,355 retail clinics in the United States; this number is expected to more than double to 2,854 by 2018, according to a report from GBI Research. In addition, the number of patients visiting retail clinics has jumped from 1.48 million in 2006 to 5.97 million in 2009 — more than a fourfold increase, according to a study published in Health Affairs.



Robert Garrett
Robert Garrett

Hospitals and health systems are increasingly joining the growing trend of retail clinics by forming partnerships or creating their own retail clinics. The appeal of retail clinics for many hospitals is their ability to provide patients increased access to high-quality, low-cost care — the top goals under healthcare reform. Here are six ways hospitals can align a retail health strategy with healthcare reform goals.

1. Increase access to care. Hospitals can use partnerships with retail clinics as a strategy to increase both patients' access to healthcare services and hospitals' access to patients, which can help hospitals coordinate patients' care better.

Retail clinics provide additional opportunities to introduce patients to the hospital and its healthcare services. Hackensack (N.J.) University Medical Center formed a clinical collaboration with MinuteClinic, the retail healthcare division of CVS Caremark, in May. "It will help communities throughout our region in terms of Hackensack University Medical Center healthcare being extended through the retail heath setting," says Robert Garrett, president and CEO of Hackensack (N.J.) University Health Network, parent company of HackensackUMC.

Feinberg
Dr. David Feinberg



Under HackensackUMC's collaboration, medical directors from the hospital oversee the care provided by nurse practitioners at MinuteClinic. "It helps to extend both the hospital's reach and our physicians' reach to our entire region," Mr. Garrett says. This extended reach can help hospitals manage their patients' health more effectively, which is a goal under healthcare reform.

2. Coordinate care. Hospitals can partner with retail clinics as a strategy to care for patients throughout the continuum of care, which can help improve the quality of care. "The retail health strategy gets into the overall strategy of building an integrated network," Mr. Garrett says. "When building a network, it's not just a network of hospitals; it also includes a network of providers, including physicians, ambulatory care centers and, in this case, retail healthcare."

Hospitals can enhance the coordination of care for patients by connecting their electronic health record systems to the retail clinics they're partnered with. This connection facilitates the transfer of patients' medical information between different sites of care, such as between a retail clinic and a primary care physician.  

Andrew Sussman2
Dr. Andrew Sussman
3. Connect patients to primary and preventive care. Hospitals can also align a retail health strategy with the goal of improving population health — one of the triple aims of healthcare reform — by using the clinics as a way to connect patients to primary care and provide preventive care.

The word "retail" in "retail clinic" may not communicate the role of the clinics in promoting wellness and population health. "I don't think of it as retail, I think of it as preprimary care," says David T. Feinberg, MD, CEO of UCLA Hospital System and president of parent company UCLA Health System. UCLA Health System formed a clinical affiliation with CVS Caremark in July, which will make UCLA physicians medical directors for 11 CVS MinuteClinics in Los Angeles County. "From a health reform standpoint, [retail clinics] allow a lot of people with insurance and new people who will get insurance to access care and ultimately get into care appropriately so they have an ongoing relationship with a primary care provider," Dr. Feinberg says.

In fact, the majority of patients who go to retail clinics do not have primary care physicians, according to Andrew Sussman, MD, president of MinuteClinic and senior vice president and associate CMO of

Matt Montgomery2
Matt Montgomery

CVS Caremark. "With the shortage of primary care providers expected to reach 40,000 by 2020 according to the American Academy of Family Physicians, we believe MinuteClinic will fill a vital role in patient care as we work collaboratively with teams of physicians and hospital systems to provide accessible and affordable care," he says.

4. Increase convenience. Hospitals' partnerships with retail clinics also provide a convenience to patients, which encourages patients to engage in their health — a critical part of meeting the healthcare reform goal of improved population health. Retail clinics are typically open on the weekend and have longer hours than physicians' offices do. "The convenience part is an important one," Dr. Feinberg says. "That's the redefining healthcare part."

Many UCLA employees have experienced first-hand the convenience that retail clinics provide. "As we were discussing [the retail clinic partnership] with the team, a confessional took place around the room, where people said, 'I went to that MinuteClinic,'" Dr. Feinberg says. "These are our own people being treated at retail clinics. It was in a confessional way saying 'We've all been there.'"

UCLA's goal to make healthcare services more convenient for patients through its retail clinic partnership is part of a larger initiative to bring care to where patients are by expanding locations in Los Angeles, according to Dr. Feinberg.

5. Become patient-centered. Providing convenient healthcare services is one way hospitals are becoming more patient-centered in their approach to healthcare, a key change under healthcare reform. "It used to be that [healthcare] was hospital-based — all the doctors had their offices around the hospital. That's provider centric. It made it easy for doctors, but not necessarily convenient for patients," Dr. Feinberg says.

A patient-centered model is consumer-oriented, shifting the focus from providers' needs to patients' needs. Hospitals can meet patients' needs by offering quality care in retail clinics. "The biggest piece [of surviving in a competitive healthcare environment] is embracing a more consumer-oriented approach and not having the strategy be driven by the physicians in terms of what is convenient to them," says Matt Montgomery, senior vice president of the healthcare division of Buxton, a consumer analytics firm. "Rather, ensuring the strategy is driven by convenience to consumers, to patients — that's the emphasis."

6. Improve quality. One of the primary goals of a retail clinic partnership is to improve the quality of care, which is also a healthcare reform goal. Hospitals aim to improve quality through a retail clinic partnership by providing medical directors to ensure the clinics follow standardized, evidence-based care and provide care that is appropriate in a clinic setting. For example, the medical director may establish guidelines of treating skin infections for only patients under a certain age, or treating a fever only when it's below a certain temperature, according to Dr. Feinberg.

Under both UCLA Health System's partnership and HackensackUMC's partnership, physicians will conduct a quality review of the MinuteClinic nurse practitioners and review their charts to ensure quality. "The nurse practitioners and medical directors are going to be reporting to each other on a daily basis with a rapid report, and with more in-depth reports on a weekly basis," Mr. Garrett says.

Can a healthcare-retail partnership work?
Hospitals may initially have concerns about partnering with a retail clinic because of the differences between the health and retail industries. "We did have reservations about [the retail aspect]," Dr. Feinberg says. "[But] we experienced the value proposition ourselves. That's how we got over the concept of retail."

Hospitals can ensure the partnership will put patients first by confirming both parties share goals of increased quality of care and convenience for patients. "A lot of it has to do with making sure communication is clear, goals are clearly stated up front and both teams connect well together," Mr. Garrett says.

While the retail clinics maintain retail's focus on consumers — in this case, patients — the financial aspect of retail is not as prevalent. "We develop clinical affiliations, not legal partnerships. And there is no financial relationship," Dr. Sussman says.  "The model is for hospital system doctors to become our collaborating physicians."

Mr. Montgomery says hospitals' adoption of some strategies from the retail industry is a positive trend. "Retail clinics are the most critical intersection between healthcare delivery and a retail-like experience," he says. "Healthcare has been long overdue in embracing a retail-like approach in terms of convenience and access to patients. We're beyond the stage where it might be a fad, a trend; it's a proven and established healthcare delivery model that is here to stay, and should be considered as part of [hospitals'] larger entry point strategy."

Are retail clinics the way of the future?

As hospitals and healthcare systems continue to seek new ways to deliver high-quality, low-cost care, the prevalence of retail clinic partnerships may increase. "We feel partnerships of this kind, whether between a hospital and physicians or between a hospital network and a retail care center like MinuteClinic — that's the way of the future; that's how healthcare is going to be provided," Mr. Garrett says.

Healthcare is moving to a model where more care is delivered in an outpatient rather than an inpatient setting. Retail clinic partnerships are one way hospitals can break into the outpatient market. "There's no doubt that much more of healthcare will be provided outside the acute-care hospital setting. This is an example of where that type of healthcare can be provided in a coordinated, high-quality, cost-effective manner," Mr. Garrett says.

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