How convenient health clinics are continuing the growth of retail health care
Retail health clinics have evolved over the years. Once a small space in the corner of a supermarket or drug store, where a shopper could get a flu shot, the clinic has transformed into a high-tech, consumer-centric health hub that provides primary care. Store chains are increasing their investments in these entities, and making sure consumers know that these in-store clinics do much more than administer vaccines or perform routine diagnostic tests.
When the convenient care industry, as the Convenient Care Association, or CCA, refers to it, debuted more than two decades ago, the establishments provided limited, affordable healthcare services for a small number of illnesses. The clinics provided an alternative to visiting a hospital emergency department for non-emergent care. If people would visit a clinic in the same place where they were shopping and getting their prescriptions filled, that would help to mitigate issues ranging from long ER wait times to the ballooning costs of health care.
During the COVID-19 crisis, retail clinics became important destinations for testing, as well as for routine care while other healthcare providers closed their offices. Then the retail clinics became sources of vaccines and other pandemic-related care. Today, the estimated 3,300 retail health clinics throughout North America are expanding their offerings to provide a range of care for consumers.
“This has been a consumer-driven industry,” said Nate Bronstein, chief operating officer at the CCA. “The clinics have adopted their scope of services for what patients need.”
Many of the clinics offer chronic disease management, respiratory care, STI evaluations and even mental health services. While the clinics are playing a larger role than ever in consumer health care, Bronstein said convenient care clinics are not trying to replace shoppers’ existing primary care providers. In fact, two-thirds of consumers who visit convenient care clinics do not have a primary care physician. “Our industry wants to make clear that we have no intent to take the patient from the physician or hospital,” he said.
[Read more: Retail health clinics play larger role in consumer health care]
CVS, Kroger, Walgreens and Rite Aid run 80% of the retail care clinics in the United States, according to the CCA. In addition to these in-store clinics, there has been growth in other convenient care clinic openings. Large healthcare systems such as Green Bay, Wis.-based Bellin Health runs FastCare walk-in clinics that charge $69 per visit, according to its website. The University of Miami Health system operates UHealth Clinics at some Walgreens locations. In July, Amazon announced it had acquired primary healthcare provider One Medical, which, while not a retail health clinic company, signals the online retail giant’s plans to extend its reach into consumer health care, after its purchase of PillPack in 2019.
Nurse practitioners and full practice authority
As retail clinics prepare for this new era in healthcare consumption, they face certain challenges. Among them are the limits on full practice authority. “It’s a policy-oriented barrier,” Bronstein said. “Depending on the state they’re in, the providers in retail health clinics, nurse practitioners or physician associates, may be required to have direct physician oversight.”
As the American Association of Nurse Practitioners explained, practice authority refers to the ability of nurse practitioners, or NPs, to evaluate patients, diagnose, order and interpret tests, as well as initiate and manage treatments. In the 1970s, states began to regulate nurse practitioners beyond their registered nursing license. Today, practice authority varies by state.
[Read more: State of play: Profiling state efforts to expand pharmacist scope of practice]
There are three levels of practice authority for NPs. Full practice, which approximately half the U.S. states and territories have adopted, refers to NPs’ ability to perform “at the top of their license.” In reduced practice states, NPs can perform some of their scope without physician supervision. In restricted practice states, NPs must have supervision or an outside collaborative agreement by an outside health discipline.
Physician assistants, or physician associates, or PAs, have similar state-by-state restrictions. According to the American Academy of Physician Associates, the different practice categories are optimal, advanced, moderate and reduced.
This physician oversight takes the form of Collaborative Practice Agreements, or CPA. The CCA, in its “2021 Retail Health Industry Overview,” noted that CPAs consist of six to nine hours a month of phone consultations and chart reviews, which adds costs to health care and limits care.
Although they have advanced degrees, NPs and PAs are considered mid-level providers, which points to another issue. “The biggest challenge is getting nurse practitioners and physician assistants paid at the top of their license,” said Meggen Brown, chief nursing officer at Kroger Health/The Little Clinic. In Medicare, third-party payors and insurance companies, there is a reimbursement gap. The amount that NPs can bill for a service is 85% of the amount a physician can bill for that service.
On the bright side, some insurance companies are more advanced on how they view NPs and PAs because these insurers understand the long-term savings. “We save them millions of dollars a year,” Brown said. “Instead of someone going to the ER for a runny nose, they are coming to us.” Kroger has 226 The Little Clinics in the U.S.
Expanded care
The pandemic helped people realize that they can visit The Little Clinic for more than a runny nose. Kroger administered 11.4 million COVID-19 vaccines, which helped millions of consumers become familiar with the supermarket chain’s healthcare services. Many have returned for everything from diabetes management to anxiety. “It’s not just vaccines, not just sports physicals,” Brown said. “If you can get it done at primary care you can get it done at retail.”
[Read more: Walmart, UnitedHealth Group partner on health services]
It helps that Kroger’s The Little Clinic received Joint Commission accreditation. “People didn’t think you could get quality health care inside a grocery store,” Brown said. “People are taken aback because it looks like a doctor’s office.” The clinics are part of Kroger’s larger goal of being healthcare destinations. The retailer also has its Food as Medicine platform, which includes nutrition education with Kroger Health registered dietitians.
Retail clinics are working on their messaging. “I think many people believe that primary care clinics located in retail have a limited set of services,” said Clive Fields, chief medical officer and co-founder of VillageMD. “Our challenge has been moving people to recognize they can get care in a convenient setting.”
Last year, Walgreens Boots Alliance announced it had made a $5.2 billion investment in VillageMD to accelerate the opening of at least 600 Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027. “We really see our retail locations as part of the continuum of how you take care of patients in offices, at home, remotely,” Fields said. “It is care built around the patient.”
Fields said the Village Medical at Walgreens clinics have been well received by patients, who appreciate the ability to fill their prescriptions and purchase other items at the same location. “There is security, free parking, and they use the healthcare professional that is used the most, which is the pharmacist,” he said. “The most common interaction in the healthcare system is primary care, and the most common intervention is dispensing of prescription pharmaceuticals.”
Stores are repurposing spaces that were once used by banks and other businesses that are moving to online customer care. “We’re going to continue building and creating locations where patients have multiple needs met at the same time,” Fields said. “Instead of patients going to downtown office buildings for health care, they will get care conveniently, especially in rural and underserved communities. “We want to build on the good work that our pharmacy colleagues have done and expand services available for folks.”
[Read more: Pharmacy as a healthcare destination benefits aging work population]
Next phases
The pandemic changed how consumers seek health care. “The past two years presented a variety of difficulties due to the COVID-19 pandemic’s impacts and other major societal events taking place in the United States,” said Angela Patterson, chief nurse practitioner officer at MinuteClinic at CVS. “After pivoting our practice, the industry now faces the challenge of determining how to move forward as we transition into an endemic care setting.”
Consumer healthcare needs have shifted. People have ongoing COVID-19 related needs as well as broader comprehensive care needs, from catching up on delayed preventative visits to meeting behavioral healthcare needs. This need for primary care is happening during an ongoing physician workforce shortage.
MinuteClinic has more than 1,100 locations in 35 states and Washington, D.C. Under its new Patient Care Transformation initiative, MinuteClinic is expanding on existing acute and chronic care services, and adding new services that offer patients more holistic care. MinuteClinic also has a streamlined referral process when a patient needs additional care. In April, MinuteClinic began a phased rollout of expanded and new service offerings in cardiovascular health, dermatology, GI/digestive health, musculoskeletal, neurology and women’s health.
[Read more: CVS Health to acquire Signify Health for $8B]
In 2020, MinuteClinic added behavioral health services, which Patterson said is an unmet need in many areas. The clinics offer mental health counseling services and treatment via licensed providers virtually and in select locations. “Behavioral health remains a key priority, and we continue to expand these services into new markets across the country,” she said.
Finally, MinuteClinic received the American Nurses Credentialing Center, or ANCC, Pathway to Excellence designation, a global credential that highlights the brand’s commitment to creating a healthy work environment where staff feel empowered and valued. Clinicians in these credentialed sites, Patterson said, have a voice in policy and practice, which results in higher job satisfaction and reduced turnover.
Staffing shortages
Job satisfaction is crucial in health care, as fatigued and dissatisfied workers are leaving the industry. Retail clinics have implemented initiatives for attracting and retaining NPs and PAs. “A lot of our members are finding ways to support and fund additional programs in schools across the country,” said CCA’s Bronstein. “That’s a long-term solution.”
CVS Health and MinuteClinic offer employees a well-being focused benefits package and access to professional development opportunities, including affordable continuing education. CVS Health has partnered with education providers, and offers tuition reimbursement and loan repayment programs. Patterson noted that the company also acknowledges post-pandemic workforce preferences, such as the option to provide care virtually.
At Kroger, one of the new benefits is mental health care, and the chain offers free mental health counseling for staff. The company also created a chief people officer position that engages with staff and creates well-being services.
Suppliers help
Retail clinics now have an opportunity to remind consumers that they are due for various immunizations, especially the pediatric vaccines that declined during the COVID-19 pandemic. “Certainly in the convenient care clinics they are able to see the whole family,” said Sandra Canally, a registered nurse, founder and CEO of The Compliance Team. “There’s a lot that is needed to get the pediatric population in the door. If they are not going to the pediatrician, they need to go somewhere, and it’s ended up being all about convenience.”
[Read more: CVS Health plans to enter primary care by end of 2022]
The Compliance Team, which runs the Exemplary Provider accreditation program and other certifications, works with clinics to help them follow guidelines such as proper storage of vaccines. Canally noted that it’s important for clinic staff to stay informed about new variants of COVID-19, new boosters and other vaccines for emerging diseases, such as monkeypox, as well as legacy vaccines such as polio, which had a case in New York State over the summer.
“It’s all about making sure their staff is aware of and educated on these infectious diseases,” Canally said. “It’s not just COVID and the children’s vaccine and monkeypox. It’s anything else that’s coming down the pike. You need to be ready with infection control policies and make sure you have protective equipment.”
Diagnostic tests are also in demand, not just for COVID-19 but for routine maladies. Jonathan C. Overbey, head of corporate alliances and channel management at Sekisui Diagnostics, said the biggest markets right now are related to strep throat and flu. “Most of the testing now is for respiratory,” he said. “Kids are back playing sports, and people are getting on airplanes. We’re getting back to what it was to some degree pre-COVID.”
Challenges such as supply chain constraints are affecting businesses everywhere, including diagnostic companies. For a while, Overbey said, raw materials shortages made it difficult to get swabs and plastic tubes. “Our suppliers have gotten better, and they ramped up production,” he said. “It takes time to build a plant.”
Amid all the challenges, clinic expansion will continue. “The thing with retail is it is uniquely driven by consumer demand,” Bronstein said. “As they ask for new things, you see these things arise.”
[Read more: NCPA survey: Three-quarters of community pharmacies report staff shortages]
Johnson & Johnson Consumer Health has a portfolio of brands that offer solutions for many retail clinic visits. During the height of the pandemic, the company worked closely with its retail partners to provide resources that clinicians could reference to help educate new and recurring patients. It produced educational materials on its products and the health needs they address, including allergy therapy and management, wound care, photosensitivity/sun protection, oral care and atopic dermatitis.
“Additionally, we have worked with the CCA to provide peer-to-peer education for hundreds of clinic healthcare providers who can use the materials to increase their knowledge of the science behind the health conditions they are likely to encounter frequently,” Johnson & Johnson Consumer Health said by email.