Last Sunday I drove to my local MinuteClinic in Cambridge, Massachusetts. I parked outside the CVS pharmacy, right by Dunkin’ Donuts and Chipotle Mexican Grill. I didn’t need an appointment. Inside the store a large screen displayed the price list. $79 to $99 for treatment for minor illnesses like ear infections or strep throat. $59 for diabetes screening. $28 for a TB test. I entered my details on a touch screen. Five minutes later, a nurse practitioner was ready to see me.
More than 1,600 such health clinics now exist in the US, located in big pharmacy and retail chains like CVS, Wal-Mart and Walgreens. Staffed by physician assistants and nurse practitioners, they provide convenient, first-contact care, seven days a week. Most accept insurance and all take cash payment. Over 10 million Americans are already visiting these clinics – a number that has spiked in recent years. It could jump again. By 2016 more than 3,000 clinics will be spread across America.
‘Obamacare’ has dominated recent discussion in US health circles. But as retail giants rapidly expand the scale and scope of their healthcare operations, what was a marginal trend may be about to disrupt mainstream healthcare.
CVS has recently rebranded itself as CVS Health. It plans to open 600 new MinuteClinics over the next three years. Previously they just treated minor conditions. Now services are expanding to include preventative health (vaccinations, screenings and so on) as well as the management of chronic conditions.
Wal-Mart, meanwhile, is positioning itself to become a serious primary care player in its own right. It will open 12 new primary care clinics across the country this year with a wide range of services. Its huge footprint across America – including rural areas that often lack primary care – makes this a fascinating prospect. What would US healthcare look like if Wal-Mart had a health clinic in all of its c. 5,000 stores?
Paradoxically, the millions of patients newly insured through the Affordable Care Act may be encouraging this trend. If you have a large deductible for accessing a primary care doctor, you probably want a cheaper alternative. Retail clinics with low rates are meeting this need.
The upsides of this model seem self-evident - affordable, fast, convenient care. A Health Affairs paper showed that nearly half of these clinic visits happen at the weekends or evenings, when finding a primary care doctor can be a challenge.
The most commonly heard objection to the retail healthcare model is that these clinics damage continuity of care. But many – maybe most – of these patients don’t have a primary care doctor.
And increasingly these clinics are plugging into the healthcare systems they work with. CVS, for instance, has affiliations with 44 health systems that allow data sharing through electronic health record systems.
Walgreens appears to be taking this a step further. Last year it announced the creation of three Accountable Care Organisations – in Florida, New Jersey and Texas - making it the first pharmacy chain to do so. It sees its role as helping to expand primary care capacity and playing a wider role in population health management.
Any lessons for the UK?
Well, some of this is already happening. Sainsbury’s has experimented with giving space to GP surgeries in a few of its stores. Lloyds Pharmacy has been developing mobile health applications. But could global consolidation in retail markets accelerate these trends? Wal-Mart already owns Asda, with over 500 stores across the UK. Walgreens had a 45% stake in Boots; this summer it took the option of buying the rest of the company.
And with A&E attendances high and rising, GPs under severe caseload pressure, and many NHS walk-in centres being closed, might retailers be prepared to play a bigger role in primary care?
People already pay retailers for travel jabs, eye tests and prescriptions. Would they trade off a small payment for convenient access to a broader range of primary care services? And what if retailers created partnerships with GPs and other providers, so that costs were not even passed onto patients?
Clearly this isn’t a solution to every healthcare problem. But next time you shop at your favourite store, why not reflect on what healthcare could learn (longer opening hours, convenient locations, clear product information, customer-focus) from the best of the retail world.
This blog also appeared in the HSJ.
Jacob West was Harkness Fellow at the Harvard School of Public Health 2014-15.
West J (2014) ‘Can big retailers transform healthcare?’. Nuffield Trust comment, 13 October 2014. https://www.nuffieldtrust.org.uk/news-item/can-big-retailers-transform-healthcare