re: If Wal-Mart Did Healthcare......

Lawrence Stiffman, Ph.D., MPH — Wed, 23 Jan 2008 20:57:28 GMT

The retail/in-store clinic movement is more than a highly beneficial strain of “disruption” to the primary healthcare delivery system. Looking forward, it should also be a significant catalyst and test-bed to improve community health status.

This strategy entails e-collaboration with a robust referral care network harmonizing enabling tools related to consumer-directed wellness, early disease detection and disease management services. Add a hefty dash of one-on-one customer rewarding based on health risk appraisal completion. Follow up with sequential adherence-based economic incentives fulfilled through behavioral target marketing with customized couponing triggered by the HRA findings, seasonal drivers, and respondent demographics. Similar reward triggering could be based on benchmark attainment within disease management protocols.

Win-wins arise building loyal families in touch with new teams of wellness providers. It’s opt-in and HIPAA immune, and is freed from the babble generated by a zillion committees, taskforces, and “working” groups intent on cyber transacting everything. To the extent progressive local and regional health systems are included, the smoother the political sailing. For example, a Blue Cross plan could co-venture production of selected services. Local VNA and health departments would continue to make excellent staffing partners for short-lived campaigns such as back-to-school vaccinations. With insurance coverage arising and rising, the customer is the beneficiary regardless of the chosen production function.

Service demand can be continuously driven by demographic (gender and age) thresholds per U.S Public Health Service guidelines. Such info is captured within the HRA completion process to trigger sentinel announcements (for example, 50th birthday) and invites along with customized coupons to promote visiting the clinic and the store. Intervention opportunities also arise seasonally. Examples include the promotion of back-to-school and vacation-prompting vaccinations, flu season shots with pneumonia piggy-backed on, spring and fall seasonal allergies, and national body part (i.e., Breast Cancer) of the month campaigns.

Why Retail Clinics as the Locus for Change?

Incumbents in the retail clinic space grow because their business case is compelling, enterprises are sufficiently capitalized and customer experiences are highly scored by all relevant satisfaction metrics. These operations are still in early growth facing normal start-up woes:

1. Uncertain ROIs and break-even points, staffing, information capture and work-flow patterns

2. “Without the doc” risk-averse service menus, voluntary script dispensing/selling firewalls, constrained spatial layouts and low-ball pricing.

Thus, there is plenty of wiggle room to now plan additional functionality as the kinks get worked out and consumer acceptance grows. As competition increases, investment drivers include the need for continuous product improvement and differentiation as well as for satisfying large customer cohorts shifting from latent to expressed demand for diagnostic, immunization and screening services. In-store worker-focused risk assessments add icing to the convenience cake, especially by filling in off-peak appointment slots, smoothing work flow and reducing queues and wait times. (Workers’ rewards must be nondiscriminatory per U.S. Department of Labor regs compared with customers’ rewards.)

Like Lipitor, the “daughter products” released after its ingestion are more beneficial than the original dose. Sensible protocol-based and decision-supported adult primary care is the core retail clinic output platform now in place. Providing appropriate consumer-assisting programs with health systems co-venturers builds upon sunk investments at low marginal cost.

In many urban and rural communities, the default locus for free “medical advice” has traditionally been the neighborhood pharmacist. The retail clinic can expand this tradition with one-on-one assistive and practical care in terms of fuller primary prevention services that are disease- or body-part specific.

Many screening and testing services have been battle-tested in drug stores, at health fairs and convention lobbies and within assorted clinics of all stripes. More recently, based on strong empirical evidence from workplace wellness settings, providing customized incentives and rewards is essential to “get people to the last mile” to initiate behavioral change. This might become an especially compelling strategy with the deployment of emerging home-based disease management products incorporating remote monitoring. Incentives could take many forms from reward programs to price discounts on in-store goods and services.

Convenient Primary Prevention Would Gain Equal Footing with Convenient Care

Given pervasive techno-chaos within the overall healthcare industry, it takes business discipline and standardization to harmonize appropriate processes and technology. Just consider the hundreds of options flowing from web-based and traditional programming in risk assessment and personal auditing and tracking programming including health risk appraisals, HSAs and derivative financial products, mini personal health records, electronic medical records, chronic disease management with remote monitoring, behavioral targeting and one-on-one relationship marketing and loyalty card systems.

Each of these now operate under different parentage – from health departments, governments, self-insured large employers, progressive unions, managed care organizations, classic insurers, marketing services firms and, increasingly, by customers themselves. Many have or will become zero-priced commodities. The good news is that all are adjunctive to enhancing the retail clinics’ care and caring missions.

The retail clinic could assume employers’ traditional role in health risk appraisal to get incentive packages, monitoring and benchmarking locked and loaded. Then, many follow-through tests and procedures are done in store with out-referral when appropriate. Record keeping would be online and really simple. It’s like installing training wheels for the emerging PHR and EMR systems. These convergent systems are typified by early developer groups such as WebMD while Google is constructing a PHR system.

Caring Processes are Inseparable from Care Processes

Retail Clinic 2.0 positioning is not glitzy PR to deflect the opening blows by organized physician groups that wrongly perceive negative competition from nurse practitioners and others. The reality is all PCPs (and, more importantly, their patients) will be universally better off if they begin to mimic some of the critical convenience, staffing, IT and pricing success factors put in place by the retailers.

The docs are far from being disintermediated; they can be emancipated from the routine sniffles and scratches while remaining wired in, utilizing their time and skills more appropriately and productively. Ditto for our under-funded public health clinics that will face huge work flow and staffing problems as prevention and wellness eventually obtain public and private core financing. Latent demand for the 55-year-olds and kids is likely to explode if Medicare expands down and SCHIP widens.

Recent AMA opening moves challenging the emerging retail clinic industry’s usurpation of physician roles and functions were inevitable. It’s fuming again but will lose the battle because:

1. Their economic self-interest becomes more visible than their patients’,

2. The inherent cost-effectiveness of the current approaches is readily apparent to customers (especially where services are insured), and

3. Business groups, governments, employers, public health associations and insurers all welcome price and quality competition wherever and whenever they find it.

If Disney Did Healthcare: Part 2

HealthBlog — Thu, 20 Sep 2007 04:44:48 GMT

Last April I posted a piece on this Blog entitled " If Disney Did Healthcare ". I commented that there

re: If Wal-Mart Did Healthcare......

hlthblog — Thu, 03 May 2007 23:37:37 GMT

Thanks for writing, Jose. You clearly "get it". But I also want to point out that the debate shouldn't be retail vs. traditional providers, but rather what traditional providers can learn from retail and visa versa, to better meet the needs of patients.

Bill Crounse, MD

re: If Wal-Mart Did Healthcare......

Jose Martin — Thu, 03 May 2007 22:55:36 GMT

You highlight "transparency" as one of the most significant innovations that retail clinics have brought. I completely agree.

Retail clinics offer transparency both in prices and in the menu of services they provide. Potential customers can easily evaluate ex ante the service they would receive. Compare this with the prevalent provision models (hospitals, physician offices), where none of these parameters is known.

Retail clinics use "exotic", unusual locations. But there is nothing exotic about their business model, based on focus on a limited scope of services, use of IT-supported protocols, and a positioning based on accesibility and convenience. Traditional providers would do well to keep an eye on this development.

re: If Wal-Mart Did Healthcare......

DaddyStarr — Thu, 03 May 2007 05:32:51 GMT

As Chief Architect of Healthwise in Boise, I have watched the emergence of this McDocInTheBox strategy from WalMart with great interest. Frankly, the current payer model is unsustainable, witness the experimentation with HSA and FSA models.

I have not looked to the marketplace to push down primay care costs, until now. I think you may be right, Bill. WalMart may genuinely change the playing field.

Heck, I'll take my kid in there for an ear infection. Why not?

re: If Wal-Mart Did Healthcare......

hlthblog — Wed, 02 May 2007 21:30:44 GMT

Brad,

While I appreciate your concerns, I think you'll find that the retail movement is every bit as emphatic if not more so as your local hospital or doctor's office about quality and the patient exierience . Afterall, these facilities have a brand to protect besides being subject to the same malpractice issues faced by any other provider.

Aided by the latest information technology and other tools of the trade, doctors and nurses working is these facilities may actually be happier with the defined hours, reduction in business hassels, and other amenities they may find while working in a retail facility.

Bill Crounse, MD

re: If Wal-Mart Did Healthcare......

Brad — Wed, 02 May 2007 20:38:44 GMT

Sweet I can't wait to go to wal mart and get checked out by an underpaid over worked nurse who is probably an illegal alien.