The Obama administration’s Affordable Care Act is slated to bring health insurance coverage to an additional 30 million Americans who are currently uninsured. With many primary care medical practices closed to taking new patients and a national shortage of primary care physicians, experts are expressing alarm over whether there’s enough capacity in the healthcare system to take on all of these new patients. While other care providers like nurse practitioners and physician assistants may be able to take up some of the slack, the mal-distribution of all types of providers and clinical facilities, especially in rural areas, is likely to be problematic for years to come.
From the start, I’ve been a big fan of the retail clinic movement. Retail clinics can not only provide baseline primary care services, they can deliver these services in convenient locations like grocery stores, shopping malls and retail pharmacies where people tend to be. Furthermore, they can often provide routine care for simple health problems at a price that people can afford. Whether staffed by physicians, or more commonly by physician extenders, these clinics are a reasonable alternative for many primary care services.
According to The ConvUrgentCare Report, there are currently 1357 retail clinics in the U.S. Operating the largest chain of clinics is MinuteClinic with 550 locations. TakeCare operates 357 clinics. The top four operators are rounded out by The Little Clinic with 80 locations and Target Clinic with 44 units. Although the growth of retail clinics slowed during the economic downturn, about 130 units have been added in the last 12 months.
Another increasingly popular trend is employer based clinics. Many large and medium sized companies have discovered the value of keeping employees healthy by offering primary care services on site. Recognizing an opportunity to grow their business, some retail clinic operators are now expanding their operations to include health clinics at employer work sites. In fact, this year Microsoft will for the first time open a clinic for its employees at the company’s headquarters in Redmond. The clinic will be operated by TakeCare.
Another interesting trend is the development of self-contained, so-called “Mini-Clinics”. I first reported on these in 2009 when I stumbled across Computerized Screening Incorporated’s booth at the annual HIMSS meeting. Last week, Charles Bluth, the President and CEO of CSI, followed up with me on what the company has been doing since our fateful meeting three years ago. The company is now offering a modular fully-enclosed, ADA & HIPAA compliant medical kiosk. According to Mr. Bluth, the new design is proving to be quite popular when placed on factory floors or adjacent to employee break rooms. Mr. Bluth says, “The acceptance of our new equipment has been overwhelming. We are seeing a dramatic usage of our system in the corporate market. On average employees are using the equipment at least once a month. With an incentive program in pace, usage goes up to as often as once a week; particularly when the equipment is placed in an exposed area such as a cafeteria or break area where employees visit on a daily basis. In addition, we are seeing a 15%+ usage on our Physician Call Service whereas the norm in the industry is 1% to 3%.”
I am aware of other companies that are also are developing modular healthcare kiosks for retail settings. Like CSI’s units, many of these provide a capability for on-demand, real-time video conferencing with health professionals like doctors and nurses who are located in other facilities, sometimes many miles away. If widely implemented, solutions like this could go a long way toward solving some of the access and cost issues facing primary care and also some of the issues around the mal-distribution of primary care providers and perhaps medical specialists as well.
Of course with commodity high-speed Internet connectivity and a variety of solutions like Kinect for XBOX, Skype, or Lync that can deliver video conferencing into the home, I foresee a day when bringing a medical or other expert into your living room for a consultation may become as commonplace as ordering up a movie on Xfinity or Netflix. Services like American Well or OptumHealth’s Now Clinic are already paving the way for immediate access to care advice and services in our homes or offices.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft