Paradigm Shift From the Medical Office to Retail Health Clinics

Retail health clinics improve patient healthcare access and prospects for primary care physicians

By Vanguard Medical Advisor Dr. Neil Baum and Marketing & Business Development Manager Madolyn Wagner

A retail clinic is a health center located within a retail grocery store, pharmacy or big box store. These clinics include MinuteClinic in a CVS pharmacy, Target Clinics, Little Clinics in Kroger grocery stores, Walmart Care Centers, Sutter Walk-In Care Clinics in California and others.

Retail clinics provide services for minor health needs.

• They do not provide care for medical emergencies.
• At a retail clinic, patients are seen by a nurse practitioner (NP) or a physician assistant (PA), who are certified to treat non-life-threatening illnesses and injuries.
• These retail clinics usually don’t have X-ray machines and other diagnostic equipment.
• They typically charge a flat fee for a particular service.
• They provide convenient, high-quality care at reasonable prices.
• Retail clinics are a cost-effective way of receiving immediate care and help control medical care costs.

These clinics represent a paradigm shift in primary care. They are not a fad, are not going away and are going to do nothing less than change the face of primary care in the United States. And now Amazon Clinics are pushing retail medicine to the virtual arena. Let’s examine why this shift in primary care is taking place.

The problem of primary care physicians

About a third of the 700,000 practicing doctors in the U.S. are primary care physicians (PCPs). They often work in group practices or are affiliated with larger healthcare systems. The practices are open during daily office hours, and a doctor is on call evenings, weekends and holidays.

Some primary care doctors are adjusting access to their care with longer hours of operation including weekends, direct email exchanges with patients and follow-up care via telemedicine.

At the same time that PCPs are adjusting their care models, there are fewer of them. A smaller percentage of medical school graduates choose primary care, opting for more lucrative specialties.

Shortage of PCPs and physician burnout factors

The remaining primary care doctors have large patient loads. The contemporary primary care physician manages 1,200 to 2,000 patients and sees 20 or more patients daily. That, combined with growing administrative tasks and ever-changing regulatory requirements, is causing many primary care doctors to report burnout, which now is more than 50%. Retail clinics are positioned to improve patient safety, coordination of services, patient satisfaction, and physician satisfaction – perhaps reducing the epidemic of physician burnout.

It is common for PCPs to spend more time on medical records and administrative tasks than being eyeball-to-eyeball with patients. This situation has deteriorated the morale of physicians who went to school to treat patients and not push paperwork.

Thanks to the aging of the baby boomer population – who are likely to require regular, comprehensive care – the need for additional PCPs is growing. The Association of American Medical Colleges predicts a shortage of 55,000 by 2032.

The lure of retail health clinics for primary care physicians

Primary care doctors in large numbers are turning to alternative models of primary care. Options include full-service, walk-in health clinics in retail stores like Walmart or at drugstores like CVS and Walgreens.

Physicians who will find the retail walk-in model attractive are those looking for collaborative, multidisciplinary team environments where physicians make decisions, not decisions made by the bean counters in large multispecialty groups and hospitals. Also, the retail mode will attract physicians looking for part-time employment.

Since the benefits of retail clinics include convenience, cost-effectiveness and quality of care, insurance companies will likely embrace these retail-based care delivery models. Aetna CVS Health plans to provide community-based access to high-quality care while delivering a more direct, responsive and affordable patient experience. From the physician’s perspective, retail clinics offer the patient’s care team a more complete picture of patient’s health to drive coordinated care with the most favorable outcomes.

Targeting chronic conditions & pharmacy partnerships

The new model, walk-in retail health clinics, will focus on the comprehensive management of patients, including chronic conditions like diabetes, hypertension and arthritis. Chronic conditions are an area PCPs traditionally help manage. Currently, 60% of Americans have at least one chronic condition, which accounts for 90% of healthcare spending.

The healthcare system needs greater collaboration between PCPs and pharmacists, which is a key component of retail health clinics. Physicians have yet to avail themselves of the benefit of pharmacists being on the caring team for patients.

Pharmacists are a valuable resource, and it is in our patients’ best interests to have pharmacists participate in patients’ healthcare. They can be helpful with drug compliance, avoiding polypharmacy and providing automatic refills, so patients don’t have gaps in their medication.

Patient difficulties with healthcare access

A major complaint of patients is the difficulty of obtaining access to healthcare. It is common for a patient to call a physician for a non-emergency problem and be told that the next available appointment is in weeks or months. This situation is unsustainable and results in complaints that the American healthcare system is not working.

The U.S. spends $4 trillion on healthcare, or nearly 18% of GDP. Yet, many Americans don’t have access to care, experience poor outcomes and defer medical care with the progression of disease and rising care costs. Nearly 50% of patients state that financial concern is the leading reason they don’t seek care.

It’s not surprising that the number of Americans who have a PCP is decreasing. A report from the Annals of Internal Medicine in 2016 reported that nearly half of the insured adults had not seen a PCP in the previous year. Among people with private health insurance, appointments with PCPs dropped 24% between 2008 and 2016, while appointments with specialists remained the same, according to a recent Annals of Internal Medicine study. Evidence supports that patients who get regular primary care have better health.

Urgent care fills the PCP gap

These patients without a PCP or having difficulty accessing care tend to utilize emergency or urgent-care options. This creates increased out-of-pocket costs, decreased continuity of care and limited opportunities for preventive care. It is generally accepted that primary care engagement improves health outcomes and lowers healthcare costs. When patient activation levels change, health outcomes and costs change, too.

Retail walk-in clinics offer fast service at nontraditional hours, which may be more appealing than primary care appointments, especially for younger people in good health who don’t have the luxury of waiting in the doctor’s office to be seen by a physician. Now major pharmaceutical chains have announced new options for patients who like one-stop comprehensive healthcare outside of the traditional care setting. These are also new opportunities for PCPs.

Retail health clinics are fulfilling the primary care role

Both patients and providers are seeking newer options to the traditional care choices. They have become a common source of care: Nearly one third of Americans visited a retail clinic in 2022. Retail clinics fill the need for quick, less complex health needs that can be served outside the doctor’s office or urgent care. However, retail clinics generally offer lower acuity type services than urgent care clinics.

Retail clinics appeared in major chain stores around 2000. Nurse practitioners and physician assistants staff them. There are about 1,800 in 44 states. The clinics aim to be convenient, affordable options for people with minor health needs. They are an alternative to urgent care centers, hospital emergency departments and primary care providers in many instances.

Patients can have a walk-in appointment at many retail clinics. However, a clinic may encourage using the internet to make an appointment ahead of time. The clinics are open during regular work hours, evenings and weekends.

Prices and copays for treatments are typically lower than an urgent care visit. Also, retail clinics have the advantage of price transparency as the fees are posted on their website or brochures available upon check-in. This is a boon for patients who often receive sticker shock when they go to the physician’s office then receive the bill later where the cost of care should have been explained to the patient before receiving medical services.

For patients without insurance, there may be a menu of services for a flat fee. At Walmart Health centers, patients can receive checkups for $30, office visits for $40, cholesterol tests for $10, sutures for minor lacerations for about $115, and dental and eye exams for $50. These retail clinics accept insurance, so patients may still have deductibles, copays and coinsurance. 

General services at retail walk-in clinics

Retail walk-in clinics have the benefits of high-quality and cost-effective healthcare services. Most retail clinics offer the following:

• Treatment for minor illnesses (sore throat, earache), injuries and skin conditions.
• Screenings and monitoring.
• Travel health.
• Wellness and physicals.
• Women’s health.
• Blood pressure monitoring.
• Cholesterol checking.
• Vaccinations.

Many offer more extensive services such as nutrition counseling, wellness classes, medication reviews to reduce polypharmacy, and help managing chronic conditions such as type 2 diabetes and high blood pressure.

Big names in retail health clinics with big plans

Walgreens plans to open 500-700 primary care clinics called Village Medical at Walgreens, in partnership with the VillageMD chain, attached to its stores over the next five years. These retail clinics will work like a traditional primary care practice with enhanced convenience, access to telehealth and in-home visits.

CVS has built 1,000 MinuteClinics in the U.S. and plans to convert 1,500 stores into HealthHUB locations. These sites will offer healthcare services such as sleep apnea assessments, phlebotomy services and more.

Walmart created new Walmart Health Centers in Arkansas, Florida, Georgia, Illinois and Texas. These are one-stop shops for healthcare featuring primary care, urgent care, diagnostics, X-rays, behavioral health and dental care services. Their differentiator is transparency and decreased cost. A primary care visit is approximately $40 for adults and $20 for children. These retail walk-in clinics are planning to recruit physicians for all these stores.

CVS MinuteClinic conveniences

CVS is a good example of how retail health clinics are structured. CVS MinuteClinic has over 1,100 locations in 35 states. Most clinics are inside a CVS pharmacy. Most clinics also offer extended hours of operation beyond regular business hours, seven days a week.

They use certified NPs and PAs to provide convenient, high-quality care at reasonable prices. MinuteClinics are integrated with major health systems in various ways. This includes partnerships with nearly 70 major health systems. As a result, these clinics provide continuity of care and allow follow-up with traditional care in the physician’s office.

MinuteClinic offers telehealth visits for remote access to healthcare services. All telehealth options are also available with or without insurance.

Enter Amazon Clinic

Taking retail health clinics a step further, Amazon Clinic offers telehealth services in all 50 states and Washington D.C. No appointments, no insurance and upfront pricing are the virtual clinics’ hallmarks. Video conferencing with a clinician is available 24/7, with messaging available in some areas.

Patients pick a clinic and compare treatments offered, prices and response times. They fill out a form about symptoms and health information, and a doctor or nurse gets back in touch with them.

Bottom line of retail health clinics for patients, PCPs and payers

Ultimately, the right choice for obtaining medical care will vary. What’s best for a patient will depend on their financial situation, insurance coverage and healthcare needs. Retail models quickly evolve based on opportunities to provide timely care at a reduced cost. While healthcare delivery in retail clinics is gaining popularity, the delivery of comprehensive, well-coordinated, patient-focused care in these walk-in clinics – and the virtual clinics – will change the playing field for primary care delivery.

These retail clinics will be attractive to PCPs who want a practice compatible with a healthy lifestyle and reduce the risk of burnout. Now, these PCPs can practice medicine without the burden of administrative obligations, which distract from providing patient care. Also, specialists can market their services to these clinics and offer follow-up care. They can make themselves available for patient referrals.

Finally, the concept will also benefit insurance companies as the reduced cost of care decreases their costs since the retail clinics provide care at a lower price.