D Healthcare Daily

MinuteClinic, the in-store retail health clinic inside CVS pharmacies, is expanding its North Texas presence with newly opened clinics in Plano and Frisco.

The company plans to add 100 new clinics a year, with the goal of having 1,000 locations by 2016. It now has 23 Dallas-Fort Worth outlets and plans to add another in Arlington this fall. Executives declined to disclose how many it ultimately plans to have locally. MinuteClinic considers DFW one of its prime markets. It entered San Antonio earlier this year.

MinuteClinics are staffed by nurse practitioners who treat common family illnesses and administer wellness and prevention services.  CVS Caremark acquired MinuteClinc in 2006 and has increased the number of U.S. locations by eight times in five years.

A 2009 study compared the care and costs of three common illnesses in several healthcare settings. It found retail clinics cost 30 percent less than physician offices, urgent care clinics and hospital emergencies departments, while delivering comparable quality.

The company sees an opportunity to provide care where there are primary-care shortages. About half of its patients do not have a primary-care physician. Another key market is an elderly population that adds 10,000 to the age 65 and over ranks every day. The proportion of elderly retail-clinic visitors grew from 8 percent to 19 percent from 2007 to 2009. Most of those visits were for flu shots.

About 85 percent of its patients are insured, and most insurers accept MinuteClinic as an in-network visit.

Most retail-clinic competitors have been reluctant to expand because it has been difficult to be profitable. However, MinuteClinic chief executive officer Andrew Sussman told Kaiser Health News in June that the company broke even in 2011 and that its revenue grew 22 percent in the first quarter of 2012.

Former Wal-Mart CEO Lee Scott pledged to open up to 2,000 retail health clinics by 2012. However, the retail giant currently has 150 clinics that comprise a pilot program. Wal-Mart began offering vaccinations for infectious diseases two weeks ago, in addition to influenza and pneumonia, at 2,700 U.S. stores.

Nearly 6 million patients visited a retail health clinic in 2009, according to a study in the September edition of Health Affairs. That represented a four-fold increase from 2007. Nearly half of those visits were on weekends or during weekday hours when physician offices typically were closed.

According to a recent survey by Deloitte Center for Health Solutions, about 1 out of 7 U.S. health consumers visited a retail clinic in the last 12 months for non-emergency care. About 1 out of 4 said they would consider visiting a retail clinic if a physician was not available.

Tom Charland, chief executive officer of Merchant Medicine and publisher of the newsletter The ConvUrgent Care Report, said the Plano and Frisco locations represent the ideal demographics for retail clinics.

“Some people mistakenly believe retail and urgent clinics are more geared to the uninsured. That’s really a fallacy,” he said. “The slam-dunk demographic is where they are located: outer-ring suburbs. When kids get sick in those households, it’s chaos. Their parents are confident in their  ability to make healthcare decisions. They just need to have the diagnosis confirmed, get it taken care of and get on their way.”

Charland said there is plenty of room for growth for retail medicine in DFW. His company has created an index that reflects the number of retail and urgent clinics per 100,000 residents. DFW has 1.7 clinics per 100,000, compared with 4.4 for Nashville, 3.6 for Kansas City and 2.0 for Houston.

Jim Greenwood is chief executive officer for Addison-based Concentra, the largest operator of urgent-care clinics. He said three key components comprise a strong retail-medicine market: affluence, youth and a shortage of primary-care physicians. He said DFW has all three.

MinuteClinic has created clinic partnerships with health systems in 19 markets, including the Cleveland Clinic and UCLA Health System in Los Angeles. Health-system physicians serve as medical directors for the retail clinics and collaborate on patient education and disease management initiatives. MinuteClinic also electronically shares medical histories and visit summaries with its partners.

Sussman told D Healthcare Daily the company “cannot discuss specifics (about possible clinical partners in ) the Dallas market.”

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.