These techniques appear to be working to change the game in walk-in medicine. It represents disruption for the disruptors and also represents much less costly approaches to competing when MinuteClinic and Take Care come to town, if they come at all.

When we refer to these “techniques,” some are the obvious ones like no appointment, prices posted and carved out services. But there are a number of not-so-obvious techniques, many of which are not available to the large operators of retail clinics.

Hospitals/Urgent Care/Convenient Care

Competing for walk-in traffic is nothing new. Hospital emergency departments were up in arms when urgent care clinics started carving out less complicated services and taking business from their walk-in business back in the 1970s and 1980s. And there are still markets today, mostly rural, where as a result of the local hospital’s clout, urgent care clinics simply do not open.

But hospitals in larger cities are becoming more sophisticated in competing for business, going head to head not only with urgent care centers, but also retail clinics.

The most obvious trend is what is commonly referred to as “fast tracks.”These are physical spaces inside the emergency department of a hospital that are carved out for more simple cases in order to reduce patient wait times and compete with urgent care and convenient care centers.The hospitals follow CMS rules that require different billing procedures and lower fees, which essentially makes these units the equivalent of an urgent care center inside an emergency room. For example, Montgomery Hospital in Noristown, PA, started its “Fast Track” for non-emergent illnesses back in 2001, when only a handful of retail clinics were just emerging in Minnesota. Today that Fast Track has dedicated space for a limited set of acute illnesses and sees close to100 patients per day.  Because of the CMS rules that lower prices, many emergency departments have gone ahead and changed the name of these fast tracks to urgent care centers.

But competition for walk-in medicine is far more complex today than just fast tracks, especially in the top 200 markets in the United States.  Many fast track concepts have evolved beyond the confines of hospitals into hub and spoke networks of acute care centers.

In Springfield, IL, Memorial Health System has a hospital with an emergency department right in the downtown center. There are no convenient care operators in Springfield, but Take Care has just opened two centers a little more than 50 miles north in Peoria. So Memorial has ringed the city with three acute care centers called “ExpressCare”that have radiology and labs, and bill out at urgent care rates. As their own marketing copy states: “ExpressCARE provides fast and affordable healthcare seven days a week with hassle-free walk-in appointments. It is the perfect alternative when your primary care provider is not available or your case doesn’t call for a trip to the Emergency Department.”

Follow Interstate 55 north to Chicago and you’ll find lots of convenient care locations. Central DuPage Hospital (CDH) is surrounded by them. In fact you can find a dozen Take Care and MinuteClinic locations within the hospital’s immediate service area. But that has had only modest impact because CDH has ringed its service area with six acute care centers it calls “Convenient Care Centers.”

Like the Express Care centers in Springfield, the CDH Convenient Care centers include radiology and labs, are staffed almost exclusively with physicians and bill out at urgent care rates. Although the centers do not currently post services and prices, the signs are in production.

“Between the six sites we do 180,000 visits a year,” said Darin Jordan, MD,medical and operations director for CDH Convenient Cares. “Most of our patients hear about us via word of mouth or are referred by their primary care physician.”

Jordan says the relationship between these Convenient Care centers and area physicians is very strong, which helps keep patient volumes high throughout the year. “They know we will take care of the problem no matter what their patients are coming in for, and they know we will send those patients back for follow-up.”

The CDH Convenient Care centers at one time included occupational medicine services, but that business outgrew the Convenient Care facilities and needed their own space. “We end up handling their overflow on nights and weekends, and they promote us to their employer clients. So the synergy is perfect,” says Jordan.

HealthPartners in Minneapolis/St. Paul is an integrated care system that includes health insurance, hospitals, multispecialty clinics and urgent care centers. The eight urgent care centers located within their multispecialty and primary care clinic facilities are not new. What is new is its Quick Clinic concept, which fast tracks patients with simple illnesses to a full-time nurse practitioner or physician assistant.Prices are posted and most insurance is accepted. Hours extend into the evenings and on weekends.

What makes HealthPartners worth paying attention to is the reverse disruption they represent to MinuteClinic, which operates more than 20retail clinics in HealthPartners’ service area. Because of the integrated delivery model, HealthPartners has both members (insurance business) and patients (medical group) who need access to care. And HealthPartners is able to direct those patients to exactly the right kind of care that meets their needs, including e-visits, tele-visits,or walk-in care.

HealthPartners also operates retail clinics just outside of the Minneapolis/St. Paul metro in St. Cloud, MN. There, the Central Minnesota division of HealthPartners has three clinics in area grocery stores. As with most retail clinics, they see patients regardless of their insurance carrier or current medical provider. Prices are posted; no appointment is necessary; all insurance is accepted; and hours are extended across seven days, including evenings during the work week.

The retail clinic practitioners rotate shifts through the main HealthPartners clinic facility. This enables the practitioners to keep up their skills outside of retail medicine, but it also enables them to establish credibility with the physicians who practice there. That credibility leads to retail clinic referrals and a very strong reputation in the community.

As mentioned above, HealthPartners is similar to Kaiser Permanente, an organization that has looked closely at the retail clinic concept. For now, Kaiser Permanente has decided not to open clinics inside retail stores partly because they serve primarily its own members and almost never accept cash paying walk-in patients. But the organization also holds very large market shares where it operates and would need more space than any retailer could give them.

That doesn’t mean Kaiser ignores convenient care concepts and techniques. They are looking at projects where medical offices are integrated into new retail developments so patients can shop or accomplish more when they go out for a doctor’s appointment.

One example is in a Kaiser Permanente office in Marietta, GA. Marietta is an upscale Atlanta suburb that is home to five retail clinics,including two Take Cares, two Little Clinics and one MinuteClinic.

More than 30 retail businesses operate at the Woodlawn Shopping Center in Marietta. Sandwiched between a karate school and a Fresh Market grocerystore, Kaiser Permanente’s soon-to-open mini-clinic will house eight exam rooms, four provider offices, a small retail pharmacy, and a general radiology room.

“We think the clinic will have curb appeal and road presence for our members,” says Michele Flanagin, vice president of delivery system strategy at Kaiser Permanente. “And having the glass storefront gives us the opportunity to promote branded graphics.”

Signage opportunities at the retail center include a common digital LCD monument sign that could alert members to flu shot clinics and other related health information. Individual media kiosks at the clinic entrance are also planned to give similar information including traffic and weather alerts.

And finally, we could help not mentioning the ultimate in convenient care:New York Presbyterian Hospital, which operates urgent care centers and fast tracks, also offers the ultimate pleaser for busy dual-income parents: “The Sniffles Club,” a day care program for mildly-ill children, ages 3 months to 13 years old.

Here is copy from their web site:

“It is ideal for children who may not feel up to attending school or their regular day care, but aren’t seriously ill and for parents who are unable to take off from work or locate a babysitter.

“The Sniffles Club is staffed by licensed pediatric nurses from the hospital’s Pediatric Unit. Parents are immediately notified if a child’s condition worsens. Depending on how they feel, children can participate in various activities. The staff will evaluate the child’s need for sleep and rest and his or her schedule will be adjusted accordingly. They can also administer medications with parental consent. Children are served meals and snacks. Special diet considerations can be also accommodated, such as kosher menu,vegetarian meals, and baby food.”

Urgent Care/Work-Site Care/Convenience Care

In future issues of The ConvUrgentCare Report we will look at the crossover between urgent care, work-site care and convenient care.Smaller, single unit operators of urgent care centers have almost always offered occupational medicine services, including DOT physicals, drug screens and worker’s comp services. And the large, national occupational medicine players like Concentra have typically not been bothered by that local competition because their focus was on large national employers. But three things have happened more recently to change these dynamics and create disruption vectors going in many directions.

First,Concentra entered the traditional urgent care space by opening many of its occupational medicine facilities to walk-in acute care patient traffic. This created the first national urgent care player almost overnight. Second, other traditional urgent care players began acquiring groups in different states to create additional national urgent care players like NextCare, Patient First, MedFirst and America’s Urgent Care. And third, Walgreens acquired Whole Health and CHD Meridian, merged it with its convenient care subsidiary Take Care and began competing directly in the employer space, including occupational medicine.

Primary Care/Convenience Care/Urgent Care

In future issues of The ConvUrgentCare Report we will also be looking at crossover with primary care. If the emergence of convenient care centers were not enough of a problem for family practitioners and pediatricians, some urgent care centers seem surprisingly overt in the way they court primary care relationships.

PatientFirst is perhaps the best example of a multistate urgent care operator entering the primary care space. The company operates 26 “primary and urgent care centers,” to use their words, in Richmond, VA, Newport News, VA, Washington, DC, and Baltimore, MD. Most are standalone centers in predominantly suburban locations open 14 hours a day, 365days a year.

Unlike most urgent care centers, virtually all Patient First sites look very similar if not identical inside and out. They clearly are promoting a national brand to an American consumer increasingly accustomed to chain concepts. They also allow patients to see their physician schedules online, knowing that patients learn to trust certain physicians and wish to maintain those relationships. And to compete with area retail clinics (MinuteClinic and Target Clinic are in their markets) PatientFirst dispenses its own prescriptions so patients don’t have to make a second stop.

For the purposes of this article we’ve attempted to organize these examples of crossover. But in reality there are too many patterns to capture in one article. The one commonality, however, is that patients have unplanned illnesses and injuries that need immediate attention. And more of them are looking for better customer service and faster turnaround. Accepting insurance plays a major role in the walk-in space, as does consumer marketing, interior design and the science of location.

So along with introducing a new name for our market report, we are also renaming our annual meeting of walk-in medicine operators to the ConvUrgentCare Strategy Symposium. Our next meeting will take place in January 2010 in Minneapolis/St. Paul. As you can infer from the date and location, this meeting is almost all work (the Mall of America is right next door!), and you’ll come way with the case studies, tools and data you need to plot your walk-in strategy for the next decade.  For more information about the symposium, click here.  We look forward to seeing you.

In case you missed it, in the last two years the start of the flu shot season has moved up considerably. And the implications for retail clinics are mostly positive. In fact, this could be the best news retail clinics have seen in a long time.

We are all familiar with the predictions of a booming retail clinic industry. But if you think those predictions have ceased, think again.  Merchant Medicine estimates 2,050 retail clinics by the end of 2014.

Of any company we have followed in the retail healthcare space, Solantic seems to hit all the strategic buttons:  stand-alone urgent care centers in high-traffic shopping centers, clinics in Wal-Mart, joint ventures with area health systems, a clinic in the Orlando airport, franchises for physicians, outstanding consumer marketing and a relentless pursuit of customer satisfaction.

He has lived in the world of corporate travel management and now the world of healthcare.  Oddly enough, the corporate travel world seems to know a lot more about Hal Rosenbluth than the healthcare world.  But that may be about to change.