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Mark Perry draws an interesting inference from two news stories: a WSJ article that suggests consumers are using less health care and another that reports a big jump in MinuteClinic volumes.
Consumers aren’t necessarily consuming less health care like the WSJ suggests; rather, they are shifting their demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics. Especially when consumers are spending their own out-of-pocket money for health care and they have a choice, they prefer market-driven, consumer-driven options like affordable, convenient retail clinics over conventional physician offices.
I think Perry is on to something. It’s hard to get people out of their established habits. They have a relationship with their own doctor, they accept the long wait for appointments and even treat it as a proxy for high quality (if my doc is so busy he must be great), and just suck it up when it comes to co-pay’s and deductibles. They want access to high tech exams and the latest drugs.
But all these things change over time. MinuteClinic and its ilk are well-positioned to take advantage of these trends in the long run. To take them in turn:
- Relationships aren’t what they once were. Your doctor may or may not remember you. If you have something routine (or even if not) you may be shunted off to see a “physician extender, ” such as a nurse practitioner. At least when you go to MinuteClinic that’s who you expect to see
- Wait times for appointment can be lengthy. Under health reform they are likely to get worse, especially since open access scheduling is slow to catch on
- We’ve now reached the breaking point for co-pay’s and deductibles. Even insured people are nervous about going in for treatment and want to save money. They realize it’s only going to get worse
- High tech exams (like MRIs) and drugs have lost some of their allure. Cost is part of it, but the continued news stories of safety problems with drugs are taking a toll, too. I think Americans are finally realizing that when it comes to health care less is often more
Finally, especially for routine issues, MinuteClinics do as well or better for quality. The reason is pretty simple: nurse practitioners are more likely to follow protocols than doctors, and the standardized MinuteClinic model represents a more disciplined approach to operations than the typical physician office.
It will be interesting to see if the substitution of MinuteClinic for the physician office is a trend that holds up over time.
David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at the Health Business Blog, where this post first appeared.
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The retail clinics do not dispense medications, they only prescribe and will send the prescription to the pharmacy of your choice. There is no pressure to get it at the store you are in. They also send a copy of the visit to your PCP for continuity of care. As noted in a comment above, one practitioner made a point of sending the prescription to a pharmacy that provided free antibiotics. The retail clinic model is still evolving.
“Still they may pull more people into the stores and are prodding regular physician offices to come into the 20th century if not yet the 21st.”
I guess that means PCPs should set up retail space in their offices to sell shampoo, toothpaste and greeting cards. Yes it’s convenient to get the chips and dip then the fever diagnosis, but I don’t think lower costs in this area are going to give us better healthcare. Forcing the further demise of PCPs is not the answer and does not promote co-ordinated care. Getting people away from ERs for minor stuff, or stuff that’s now acute because they couldn’t get PCP care is where we should focus.
Thanks for the comments. A couple things: MinuteClinics are not fronts to sell prescription drugs as MD as HELL says. See comment #1 from Nate for a more typical example.
It’s true that MinuteClinics are probably not that profitable even at high levels of utilization. The retail space is valuable and they aren’t performing high-dollar procedures. Meanwhile NPs are expensive. Still they may pull more people into the stores and are prodding regular physician offices to come into the 20th century if not yet the 21st.
I’m sure all these comments are well-meant, but they are for all practically purposes irrelevant; primary care WILL be “re-invented” in some fashion by a combination of consumer-side economic pressures (tho these are far from as crucial as free marketophiles like Mark Perry would have us understand), changes in technological capacities and peoples’ preference for ease & convenience in their routine services.
Why? Because primary care has been in the course of re-invention for at least a generation already.
Couple of good points here.
1. As Wendell says, are they loss leaders to sell drugs?
2. As MD says, is there pre$$ure to prescribe unnecessary drugs. Although I’m not sure it would be any more than the demand created by drug ads and doc detail drug sales reps.
What is old is new again… “quick care clinics” have come and gone many times over the past few decades- are they really the end all and be all answer this time? I think they have a role, but certainly don’t solve everything- and there major benefit may be in making doctors think more innovative about how they deliver their care for low complexity cases.
More specifically – let’s start with the clinical perspective: there will be anecdotal stories of great convenience, but also s those of horribly missed diagnoses. From an efficiency perspective, there will be wonderful stories of quicker access vs. going to the a standard practice… but two things are critical to understand
1. There are not enough NPs and quick care clinics to truly handle all the demand out there.
2. Practices aren’t going to stay standard forever. Many are now doing virtual visits via phone or the web – and hey, that’s even easier and more convenient than having to find a clinic with an NP and register there. So boom… the efficiency rod strikes right back at them.
Of course, the truth is that there is PLENTY of DEMAND right now, and not nearly enough supply, so everyone will be busy for awhile. But this is an important time for care providers to start rethinking how they deliver care, especially to the “easy, highly structured” cases (e.g. URIs, UTIs, as well as stable Htn, DM…) and hopefully we will start seeing more innovation in this model – thus freeing up doctors to have more time for the more complicated cases as well!
I wrote a more thorough review of all this back in 2007 when the same questions were coming up… check it out:
http://tinyurl.com/27vet7x
A minute clinic visit.
A prescription for high-dollar medicine.
Refills for a year.
How much do you need to worry about the visit if you own the whole enchilada?
Decades ago they seperated MD from dispensing. Why?
Now the reverse is OK? Why?
The viability of Minute Clinic-type facilities appears to still be questionable.
So far as I can tell CVS does not report or discuss the operating loss or income from Minute Clinic operations. That of course would be useful to know along with details on per-facility financial performance along with details of revenues and costs on a consolidated contribution margin basis.
My guess is that to achieve break-even financially such facilities will have to progressively offer more services with the same guaranteed, ex-ante pricing along with more time for usage of the facilities to become routine for a sufficient number of patient/customers.
I have used MinuteClinic and TakeCare and for routine needs they are heads and shoulders above trying to get into seeing your usualt doc. I was sick for a few days a few months back and one morning decided to see someone about it. I was in and out in 17 minutes. I’ve never checked into a doctor’s office or Urgent care that quick let alone been treated and out the door.
The nurse even sent my Rx to Giant Eagle where it would be free instead of pushing me to fill something at CVS.
Every time I have used one of these it has been a great experience. Hopefully if they start to take off again Wal Mart will get behind it again and really shake things up.