Retail Clinics and population health

tanya

Retail clinics (RCs) initiated as a response of the market to unmet needs of healthcare consumers for accessible, convenient, and cost-effective basic health services. As the clinics become a popular means of treating minor medical conditions at lower costs, they have established a niche in the health care system based on their convenience and accessibility for both insured and uninsured patients. Retail clinics are typically located in store chains that patients already visit on a regular basis, such as CVS, Walgreens and Wal-Mart.

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The clinics can operate under three different business models: 1) the clinic is owned and operated by the parent store that houses it; 2) an independent company owns the clinic and partners with a retail store to house it; and 3) an integrated model where the clinic is owned by a hospital, a physician group, or another health care provider. Nearly three-quarters of clinics follow the first model (RAND, 2010).

The rapid expansion of RCs is attributed to costumers’ favorable response to the model. Convenient hours and locations are major factors in choosing the clinics. RCs generally employ a nurse practitioner or a physician assistant with off-site supervision by physician medical directors, providing services at accessible locations, shorter wait times, and lower costs.

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Despite being a relatively new phenomenon, these clinics have the potential to increase access to basic health services to the underserved population. RCs have the necessary infrastructure –capacity for 17 million visits a year (Bureau of National Affairs, 2009)– to alleviate the shortage of primary care physicians that is intensified by the increase in demand for health services as a result of the 11.4 million newly insured under the Affordable Care Act. However, retail clinics have faced financial barriers to establishing contractual relationships with Medicaid. Also, they have to deal with state-level regulatory constraints including scope of practice laws and prohibitions against the corporate practice of medicine. These restrictions tend to limit the clinics’ ability to operate in medically underserved areas (Bartlett, 2011).

Massachusetts became the first state that adjusted its regulatory framework to fit RCs into their health system, by enacting in 2008 new regulations that specify the medical conditions and age groups that may be treated at the clinics. This proactive approach to design a tailored regulation for the operation of RCs is a good example for other states to consider how to better integrate RCs with traditional models of care. States Departments of Health play an important role in the development of this model, which has the potential to improve population health outcomes and decrease healthcare costs.

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