Diagnostic centers at nexus of health care
No picture of the evolving landscape of retail health care would be complete without including the growing nationwide network of diagnostic screening centers. Serving patients on both an appointment and walk-in basis, the centers sit at the nexus of healthcare decision-making, serving as a bridge and decision-making tool for primary care doctors, specialists, hospitals, ambulatory care centers and pharmacies.
The field is dominated by Madison, N.J.-based Quest Diagnostics, which now operates testing labs and patient service centers throughout the United States and in many foreign countries, but many regional and local testing centers also are luring patients and their physicians with a growing menu of health screenings.
Diagnostic work at the centers can range from blood work for a wide range of disease screenings to MRIs, ultrasound, digital mammography and radiology. Results are quickly available both to patients and their health providers.
The market for such services is significant. To cite an example, Quest reported revenues of $3.8 billion for the first half of fiscal 2012 ended June 30, with operating earnings of $670 million.
Retail clinics gain new respect
As health costs and doctor wait times mount and health reform ushers in an integrated team approach to patient care, retail health clinics appear poised for another growth surge.
Among recent developments: CVS Caremark’s MinuteClinic unit will expand to roughly 1,060 clinics by 2015 to keep up with booming demand; Massachusetts has broadened the preventive and diagnostic services clinical nurse practitioners can provide; and South Carolina’s retail clinics now can provide preventive and acute care to Medicaid patients.
Two powerful forces are driving the surge: access and cost. There’s growing recognition among providers and payers that retail clinics are a cost-effective solution to both the shortage of primary care physicians and spiraling health costs. “Patients will go any place that saves them money,” observed Ken Berndt, CEO of Careworks Convenient Healthcare, the clinic and urgent-care division of Geisinger Health System in Pennsylvania.
But “even above cost” on patients’ priority list, he said, is to have ready access to a health professional — be it a pharmacist, a nurse practitioner or physician’s assistant in a walk-in clinic, or a primary care physician. “Patients want care when they want care,” said Berndt.
With “the increasing shortage of primary care physicians across the country,” noted Tine Hansen-Turton, executive director of the Convenient Care Association, “nurse practitioners and physician assistants … will, more and more, be looked to as key front-line primary care providers.” What’s more, she added, the industry’s nearly 1,400 clinics comprise “the lowest cost, nonsubsidized providers of primary health care” at a time when “many consumers’ out-of-pocket costs go up.”
Retail clinics — along with the nation’s roughly 9,000 urgent care centers — also will play a critical role as reform spawns new concepts like accountable care organizations and medical homes.
The medical establishment, for its part, seems at last to be embracing retail care centers as a source of relief to overcrowded waiting rooms and overloaded primary care physicians. In May, the influential Journal of the American Medical Association featured an article extolling the virtues of retail clinics and a team approach to primary care.
“With good communication between multiple specialists, convenient access in evenings and on weekends, and familiarity with local community resources, the retail clinic potentially could be an important component of coordination of care aimed at reducing disease exacerbations, unnecessary hospitalizations and adverse drug interactions,” noted JAMA contributor Christine Cassel.
Hospitals embracing retail health concepts
A paradigm shift is under way in U.S. hospitals. To keep pace with health reform, the rise of accountable care organizations and the growing empowerment of informed and cost-sensitive patients, hospital-driven health systems nationwide are joining the retail health revolution.
As Paula Crowley reports in the publication Hospitals & Health Networks, “Healthcare consumers value what all consumers value: convenience and customer service.”
That reality, Crowley noted, has redefined the way hospitals and health systems deliver ambulatory services by adopting “the fundamental principles of a profitable retail center: location, access, visibility, convenience and customer service.” She cited several examples of hospitals and rehab centers that have overhauled their central atriums with features like natural lighting, gardens, waterfalls, spacious and comfortable waiting lounges, cafes, in-house stores selling rehab equipment or other amenities.
Increasing patients’ access points to a health system is a key driver in the retail health revolution. But the hospital industry’s embrace of a retail health model also comes in response to a fundamental shift in the way public and private health plans pay for care — from a fee-for-service reimbursement model to one based on successful patient outcomes. That shift is fueling the rise of ACOs and more cost-effective health delivery systems, based on electronic medical records and a more integrated, holistic view of the patient that extends well beyond his or her care within the hospital through outpatient pharmacies and other initiatives.
“With payers moving toward paying for quality and … the continuum of care, you’ve got to have an ACO, and you have to offer some retail [healthcare options],” asserted Ken Berndt, CEO of Careworks Convenient Healthcare, a division of Danville, Pa.-based Geisinger Health System. “You have to have low-cost access seven days a week.”
The electronic integration of patient medical records also is vital to “protect the continuum of care,” Berndt told DSN. “All our facilities share the same EMRs, including our Careworks retail clinics and urgent care centers, our medical homes and our hospitals,” he said. “So patients can freely flow back and forth, and everybody has access to all the medical information in the chart. It really does speed up care and makes it easier to know what to do with prescriptions and other services.”