Michael Dowling: Challenging one of healthcare's savior myths

"We're our own dragons as well as our own heroes, and we have to rescue ourselves from ourselves." My colleagues in healthcare may relate to those words, written by author Tom Robbins. They apply to any leader in any sector of healthcare. As the CEO of New York's largest health system, I see all too clearly how the decisions we make each day can either push the industry forward or set it back.

In fact, this is true for any organization in each sector of our industry — pharma, insurers, hospitals and retailers. Not one will save or improve the industry alone. 

I attend many healthcare conferences and meetings around the country, and I read my fair share of newspapers and periodicals. Recently, I've noticed the self-described "heroic" role that retailers are assuming in the narrative of American healthcare. If you believe what you hear and read, retailers are saving healthcare consumers from the shortcomings of our delivery system. If it wasn't for the retail clinics, nothing about healthcare would change for the better. With all due respect, I wholeheartedly disagree.

Over the past few years, we've encountered the same attitude from other consumer giants that promise to transform healthcare by changing the way it is delivered, with greater access and more sites of care. I find this particularly irritating because it's not true and it's a painfully simplistic assessment of healthcare's real "dragons," to use Mr. Robbins' word.

There are already more than 2,700 convenient care clinics operating in 44 states and Washington D.C., according to the Journal of mHealth. I support efforts by CVS, Walgreens, Kroger, Walmart, Rite Aid and other retailers to expand access by offering walk-in clinics in their pharmacies, big-box or grocery stores, but the reality is that in most markets and communities, health systems have already enhanced access to care and given patients and consumers many options to manage their health.  

Over the past decade, most healthcare providers across the country have significantly expanded their ambulatory presence. Northwell Health's revenue is now evenly split between the inpatient and outpatient care it delivers. Ten years ago, 75 percent of our revenue came from inpatient care and 25 percent outpatient. Today, we operate nearly 800 outpatient facilities throughout the New York metropolitan area, including 52 urgent care centers and 220 primary care practices. 

Location is only part of the equation when measuring access to care, which is not as simple as establishing brick-and-mortar presence on a street corner. Retail clinics primarily treat relatively healthy patients with minor illnesses, whereas urgent care centers, primary care practices and other community-based facilities operated by hospitals and health systems are capable of treating chronic conditions that often require specialty and follow-up care.  

Access also involves insurance and the ability to pay. Retail clinics are unlikely to care for people who are uninsured or can't pay, and those patients often end up in hospital emergency departments, which are required to treat patients under federal law. Hospitals remain the safety net for all if and when options narrow for patients of certain demographics. 

Health systems offering patient-centered medical homes are already in a strong position to provide patients with a full continuum of care and access to a comprehensive range of other services they may need. Primary care physicians work with specialists and healthcare professionals to manage patients' care plans and link them to community resources as needed. Most patient care is provided in the same location, reducing patients' need to travel, and integrating all of this information into a single EHR reduces the need for duplicative testing and imaging. Unless retail clinics operate in partnership with a health system, they are often limited by legacy EHRs. Most concerning, they may be unable to connect patients with complicated conditions to the specialty care they may need. 

When it comes to convenience, urgent care centers are open 365 days a year with early-morning and evening hours that match the expediency of retail clinics. At Northwell, we even offer patients the ability to check urgent care center wait times online, schedule a specific appointment time if they wish, and pre-register for a paper-free experience that helps avoid delays. To avoid surprises, we also publish pricing and insurance information online. It's worth noting that many primary care practices have also expanded their hours of operation to make it easier for individuals and families to access care in the communities where they live and work.

While those of us on the front lines of care at hospitals and health systems recognize that we have moved aggressively to expand access points for patients, the growing prevalence of retail clinics does present opportunities for partnership, particularly when it comes to offering follow-up or specialty care. As the broader narrative about American healthcare continues to take shape, the industry and patients would be better served if we think about retail clinics and health systems as complementary forces that can work collaboratively to ensure people have many healthcare options, regardless of their zip code, neighborhood, socioeconomic standing, work hours or health plan. It's a cause that no one sector can address alone. 

We invite our like-minded retail colleagues to join us in this effort instead of touting themselves as saviors of a dysfunctional healthcare delivery system. Working together, we can be the "heroes" described by Tom Robbins who can help fulfill our mission of improving the health of the communities we serve.

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