Retail Clinics Report (Part I): Extending Primary Care — 68% of Patients Express Interest in Using Retail Clinics for Chronic Disease Management
Chronic diseases are characterized by prolonged courses and persistent conditions. Once contracted, they not only impair patients’ labor capacity and quality of life but also incur exorbitant medical expenses, thereby increasing the economic burden on society and families. In the United States, 86% of all healthcare expenditures in 2010 were directed toward patients with chronic diseases, with 20%–29% of treatment costs attributed to potentially avoidable complications. Non-adherence is often the primary driver of elevated medical costs: each patient incurs an annual expense of $2,000–$8,000 due to non-adherence. Therefore, reform and improvement in chronic disease management are urgently needed.
While the model of establishing “retail clinics” by setting up clinics within chain pharmacies and having family physicians and general practitioners provide services on-site is still uncommon in China, it is no longer a novelty in the United States.. In particular, since the implementation of the Affordable Care Act (ACA), retail clinics have become the fastest-growing model in the U.S. pharmacy sector and an indispensable component of primary care in the United States. Due to their advantages in convenience, speed, affordability, and insurance reimbursement, they have gained increasing favor among major U.S. retail giants and patients in recent years.
Although retail clinics have begun offering certain chronic disease management services since 2013, their presence has remained relatively limited. With the U.S. government’s push toward value-based care, new payment models are becoming increasingly prevalent. Bolstered by this trend,Retail clinics are able to collaborate deeply with healthcare systems, adding more chronic disease management services to their operational offerings.This is a highly positive development, as the integration of retail clinics enables patients with chronic diseases to access healthcare services more easily. Furthermore, it can enhance patient engagement, reduce healthcare costs, and ultimately improve treatment outcomes. Therefore, with evolving payment models, retail clinics are poised to play a significant role in the field of chronic disease management.
In October, Deloitte released the “2016 U.S. Health Care Consumer Survey.”VCBeat has excerpted the main body of the report for you, published in two parts: Part I and Part II.This year’s Deloitte Health Care Consumer Survey Report provides a comprehensive analysis of the role retail clinics can play in chronic disease care amid the health care system’s transition from fee-for-service (FFS) to value-based care, as well as how they should meet the needs of the health care system. In this first installment, we will focus onThe Roles of Retail Clinics and Healthcare Systems in Chronic Disease Care Collaboration Under the New Landscape, and Corresponding Partnership Models。
Deloitte’s “2015 U.S. Health Care Consumer Survey” found that only 11% of retail clinic users managed chronic conditions at these clinics. Although actual utilization rates were low,The majority of patients (68%) still expressed interest in using retail clinics for the treatment of chronic diseases.Patients who are reluctant to use retail clinics primarily cite the desire to maintain continuous relationships with their physicians, skepticism about the quality of care provided at retail clinics, and a preference for receiving all medical services at a single location to ensure that their clinical information is stored in the same place or system. Although retail clinics are still in the early stages of development in the field of chronic disease management, they have already delivered substantial benefits to retail clinics themselves, healthcare systems, patients, and health plans (see Figure 1).
Figure 1. Potential Benefits for Stakeholders Involved in Chronic Disease Management at Retail Clinics
As the U.S. population ages and demand for healthcare services rises, regions with shortages of physicians are suffering from inadequate medical care. When collaborating with healthcare systems, retail clinics can serve as an extension of primary care, providing additional access points beyond traditional physician offices or hospitals. Currently, the role of retail clinics as an extension of primary care mainly involves treating minor acute conditions and administering flu vaccines; however, reduced cost pressures driven by value-based payment models will encourage traditional healthcare providers to increasingly leverage retail clinics for delivering chronic disease management services.
Today, mature partnerships between providers and retail clinics remain rare. This largely reflects the impediments to collaboration posed by the prevailing fee-for-service (FFS) reimbursement model, under which retail clinics may be perceived as competitive threats to physicians and health systems. However, the ongoing shift toward value-based payment models is now encouraging cooperation between providers and retail clinics. In a value-based framework, competition ceases to be a contentious issue, as rewards are directed to physicians who deliver healthcare services in the most cost-effective manner. Indeed, many industry executives interviewed by VCBeat believe that providers adopting value-based care are more willing to collaborate with retail clinics.
An executive stated, “Physician groups under risk-based arrangements are more inclined to collaborate with external organizations, such as retail clinics; whereas physicians operating under the fee-for-service (FFS) model find it difficult to accept such partnerships due to the competitive relationship between the two parties, which results in lower collaborative value.”
The recently enacted MACRA will accelerate the transition to value-based payment models. It encourages healthcare systems to seek clinical partnerships to help improve their cost control and quality of care. Starting in 2019, clinicians (including physicians, nurse practitioners, and all other eligible Medicare clinicians) will be reimbursed according to MACRA requirements.
This will strongly incentivize them to focus on managing overall healthcare costs and improving the quality of care. At that time, retail clinics, as partners in delivering chronic disease management services, will become increasingly attractive by leveraging their advantages, including easy access to care, protocol-driven workflows, and low-cost structures.
As a collaborative partner, retail clinics offer numerous advantages valuable to healthcare providers: convenient and accessible care for patients; expertise in protocol-driven processes; experience operating in high-volume, low-cost environments; and extensive patient analytics data. Furthermore, they hold the potential to leverage these strengths to enhance patient engagement, improve treatment adherence, and ultimately achieve better health outcomes. By implementing appropriate safeguards for privacy and security, retail clinics can utilize their expertise to collect, analyze, and leverage consumer data, thereby influencing consumer behavior.
For example, analysis of consumer purchasing patterns can enable targeted invitations for potential users to undergo health screenings. Many retail clinics are also experienced in leveraging social media to enhance patient engagement, and their expertise can help healthcare systems foster more meaningful interactions with both prospective and existing patients.
Retail clinics are playing an increasingly significant role in the management of chronic disease care, substantially improving patients’ access to medical technologies such as telemedicine and remote monitoring tools. Telemedicine enables patients to receive healthcare services through connected devices (e.g., computers, smartphones, tablets, or health kiosks), thereby reducing the need for in-person visits. Furthermore, many routine examinations, tracking, and analyses (such as blood pressure or blood glucose measurements) can be automated via the remote use of smart devices, such as connected blood pressure cuffs or continuous glucose monitors.
Although emerging medical technologies may alter certain patterns of provider–patient interaction, other studies have indicated that many consumers still desire to maintain face-to-face contact with their regular healthcare providers, including clinicians at retail clinics.
Therefore, as part of a broader healthcare team, retail clinics can provide non-virtual medical services to patients who prefer traditional face-to-face consultations, and help those in need access telehealth technologies through facilities such as health kiosks and telehealth stations staffed by on-site nurses.
Establishing telehealth stations staffed by on-site nurses can help retail clinics expand the scope of their medical services, offering potential benefits that surpass those of standalone telehealth or retail clinic models: In addition to the standard scope of practice for nurse practitioners, patients can access more specialized clinical care; meanwhile, nurse practitioners can also perform physical examinations for patients that cannot be conducted through remote consultations.
Healthcare systems also make significant contributions to partnerships with retail clinics. In these collaborative relationships, the competitive advantage of healthcare systems lies in their clinical expertise, particularly in managing complex patients and conditions; consumers recognize the brands of healthcare systems and trust their reputation in chronic disease management and specialized medical care.
Furthermore, healthcare systems possess the experience to operate complex IT infrastructure, including specialized personnel and the maintenance and enhancement of their IT investments. Finally, healthcare systems can facilitate physician engagement in collaborations with retail clinics. As overarching institutions, healthcare systems can educate physicians on the benefits of such partnerships, helping them overcome reservations and psychological barriers; establish referral mechanisms to help both providers and patients manage costs and improve care quality, thereby benefiting patients (see Figure 2).
Figure 2. Distinct Contributions of Retail Clinics and Suppliers in Collaborative Chronic Disease Care
Retail clinics and healthcare systems should leverage their respective strengths within partnerships. Retail clinics can contribute facilities, operational expertise in executing protocol-driven clinical workflows in high-volume, low-cost settings, and marketing proficiency. In contrast, healthcare systems can provide clinical leadership, patient referral networks, brand reputation, and ongoing training and education for physicians and clinical staff.
The collaboration models between healthcare systems and retail clinics are primarily categorized into the following three types:
Contractual Relationship.Retail clinic operators can enter into risk-based performance contracts with healthcare systems as members of the healthcare system’s network. Under such models, retail clinics are responsible for submitting treatment outcomes and making necessary investments in areas such as improving healthcare delivery and quality reporting; the healthcare system’s control over and investment in retail clinic operations are minimal compared to other models. This model is suitable for healthcare systems that have Medicare Advantage businesses or have entered into comprehensive risk contracts with private health plans or public payers.
Joint operation.Retail clinics and healthcare systems can jointly own and operate retail clinics. This model allows for varying degrees of collaboration and risk-sharing between retail clinics and healthcare systems. Under this model, the healthcare system’s investment and its ability to control clinical operations—including site selection, scope of services, branding, and staff recruitment and training—will be greater than under a contractual model.
Retail clinics can leverage the clinical expertise, IT infrastructure, and even human resources of healthcare systems. Such partnerships enable retail clinic operators to attract more patients, build a reputable brand, and provide training opportunities for their staff. For healthcare systems, these collaborations improve access to care for existing patients, increase outreach to untreated populations, and expand physicians’ patient panels. Through this robust portfolio of primary care services, healthcare systems are better positioned to operate within a value-based care environment. This model can be integrated with performance-based contracts.
Healthcare System Ownership.Healthcare systems can either purchase existing retail clinics from retailers or lease space to establish their own retail clinics. Healthcare systems will benefit from acquiring already-established retail clinics and will exercise full control over clinic operations. Retailers can benefit by retaining retail clinic setups within their storefronts, thereby eliminating the need for ongoing investment in the development or maintenance of these clinics. However, this model requires healthcare systems to possess robust operational expertise in running retail clinics, a capability that not all healthcare systems have.