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Solution Framework of Market Forces

Minute Clinics, excerpts:  "Empowering Patients and Improving Public Health"

NCPA article by Devon M. Herrick, Ph.D., Mar 2009

Retail Clinics.

Walk-in clinics are small health care centers located inside big-box retailers, or storefront operations in strip shopping centers. They are staffed by nurse practitioners and offer a limited scope of services but added convenience.

Originally, patients were expected to pay the cost out-of-pocket. However, as the service has proven to be convenient and efficient, insurers are beginning to reimburse for the service.

MinuteClinic is the pioneer of clinics operating within larger retailers — allowing shoppers in Cub Foods, CVS pharmacies and Target stores to get routine medical services such as immunizations and strep tests. No appointment is necessary and most office visits take only 15 minutes.

MinuteClinics clearly list prices, which are often only half as much as a traditional medical practice — most treatments cost $59.  MinuteClinics use proprietary software to guide practitioners through diagnosis and treatment protocols based on evidence-based medicine.

In contrast to standard physician practice, medical records are stored electronically and prescriptions can also be ordered that way. There is also evidence that the quality of routine care in walk-in clinics is comparable to treatment in traditional physicians‘ practices. MinuteClinics received high marks for quality of care in the recent Minnesota Community Measurement Health Care Quality Report.

The report measured appropriateness and quality of care for two common ailments among children: colds and sore throats. For example, in treating sore throats, each medical practice was evaluated on the basis of whether they administered a strep test and only prescribed antibiotics when test results were positive.

For appropriate care: 

  • MinuteClinics scored around 99 percent.
  • Mayo Clinics scored 77 percent.
  • The average provider rating was 81 percent.
  • The lowest provider score reported was 26 percent.

On care of children with colds:

  • The Mayo Clinics scored 95 percent.
  • MinuteClinics scored 87 percent.
  • The average provider rating was 84 percent.
  • The lowest provider score reported was 37 percent.

MinuteClinics scored at least as well as the average and there was far less variation. To be successful, retail clinics must provide consistent, high-quality service and a way to share patient information with customers‘ primary care physicians. These require the use of technology, including computerized protocols, decision-support tools and EMRs.

When patient records are stored electronically, it is more efficient and accurate to prescribe electronically than to handwrite a paper prescription that is then transcribed into an electronic record. Furthermore, the use of EMRs and electronic prescribing allows for error-reducing software to check for drug errors, patient allergies, contraindications and drug interactions.

These are systems that health care reformers believe all doctors should adopt, but few actually do. However, in these cash-pay markets, providers have adopted quality-enhancing information technology because their business model virtually requires them to do so. Without it, retail clinics would find it difficult to compete.

Many other entrepreneurs are launching similar limited-service clinics. Wal-Mart leases space for walk-in clinics to MinuteClinic and RediClinic (among others) and has begun to expand these operations nationwide.

RediClinic also allows patients to order numerous lab tests for fees that are nearly 50 percent less than tests ordered by physician offices. Competition from these new clinics may lead traditional physician practices to adopt new technology and offer more convenient weekend and extended hours.