4 Takeaways from Survey on Retail Health Clinics and Quality

The continuing rise of retail health clinics throughout the U.S. has significantly increased convenient access to care for vulnerable populations seeking quick resolutions to common ailments or wanting a COVID-19 vaccination. But how do they stack up against care delivered in primary care practices and facilities managed by hospitals and health systems?

More than 70% of health care leaders globally believe the quality of care in retail settings is lower than in primary care practices, according to survey findings from NEJM Catalyst Insight Council members published in October. Nearly half of 767 respondents (including 513 from the U.S.) also voiced concerns about the difficulty of tracking patients who use retail clinics over time along with challenges in managing continuity of care.

Nevertheless, 66% of survey respondents globally say that the pandemic improved patient views on retail clinics.

A Wake-Up Call on Convenience and Better Access

Interviews that NEJM Catalyst conducted with respondents provided context on these issues, with Dennis Jolley, system vice president of strategy and planning at UW Health in Madison, Wisconsin, noting that the pandemic provided a wake-up call for providers about the need to improve patient access and convenience.

Now that the worst of the pandemic appears to be over, patients who used virtual visits or retail clinics are more comfortable with these options because they have experienced them, Jolley said.

Respondents’ concerns about quality are likely related to differences between episodic and longitudinal care strategies, Jolley explained. Retail health tends to be episodic while good primary care is more longitudinal.

For health systems, the two biggest benefits of owning or partnering in retail care are to improve access to care (cited by 52% of respondents) and meet consumer demand (48%), an indication of the role that retail care is playing in fulfilling unmet patient needs. Another important finding, respondents say that retail care helps meet the needs of vulnerable populations, with two-thirds (67%) reporting that the use of retail health care delivery has increased access for this group.

The Continuity of Care Conundrum

Providing continuity of care among retail clinics and primary care practices, hospitals or health systems is a key concern for roughly half the U.S. respondents. The two biggest challenges for health systems of owning or partnering in retail care are the difficulties of tracking patients over time and transitions of care, cited by 46% and 50% of the U.S. respondents, respectively.

Some are concerned that preventive screenings may not be done when care is episodic and that retail care will erode the continuity of care and increase the total cost of care in the end. David Fairchild, M.D., chief medical officer for MinuteClinic at CVS, challenged this latter notion in an analysis of the survey findings.

Fairchild says the quality concerns raised by health care leaders are not necessarily unique to retail care and are found throughout health care delivery. He notes that the field still does not have a common way to share medical information due to interoperability issues and myriad different electronic health record systems.

Will Providers Build a Retail Presence?

Despite the growth of retail health clinics, only 15% of respondents own or have a formal relationship with these outlets; another 10% say their organization is planning an affiliation within the next three years.

And in terms of what they view as the greatest outside competitive threat to traditional health care institutions, more than half the respondents (56%) cited direct-to-consumer telemedicine by a wide margin versus 16% for retail clinics and 13% for urgent care clinics.

As for how hospitals and health systems can respond to current trends in retail care, U.S. health care leaders offer four insights.

INSIGHT 1 | Expand primary care access and new modes of delivering treatment.

Statistics show as many as 25% of Americans do not have a primary care provider. Consider providing an additional access point for consumers who do not have a primary care physician. Be prepared to address care coordination, a potential rise in patients with chronic conditions and the ability to make timely referrals to specialists.

INSIGHT 2 | Uberize care with GPS-enabled smartphones and intelligent navigation to match immediate demand to care coordination.

Traditional care delivery systems need to re-examine access and ways to make it easier for patients to get the care they want when they want it and where, noted one executive. Meet patients where they are — on their mobile devices, at home, at work or on the road.

INSIGHT 3 | Consider focusing on in-home care.

More than 40% of U.S. respondents say that in-home care will reduce demand for retail care. But as we’ve seen with other retailers getting involved in health care, a growing number are looking to expand operations into home care. Be prepared to differentiate your services.

INSIGHT 4 | Partner and coexist with retail care.

Traditional practices and organizations often are not nimble enough to meet same-day, urgent care needs for basic acute care like treating strep throat, noted one CMO from a U.S. nonprofit research facility. The flip side: Retail clinics will free up time for primary care physicians to spend on higher-acuity patient issues.