Northeast Ohio’s ballooning health care infrastructure might be dominated by big-box bricks and mortar, but a less-assuming version of care is unfolding in neighborhood convenience stores.
Retail clinics — basically, small offices housed within drug stores like CVS or Walgreens — are nothing new, but a handful of new players recently entered the fold and are promising to shake up an already-competitive market for low-cost, on-demand services for non-emergency health care needs such as sinus and ear infections, sore throats or rashes.
HealthSpot, a Columbus-area company, recently rolled out its virtual walk-in health care kiosks at 25 Rite Aid stores throughout the state, including 18 in Northeast Ohio. HealthSpot’s kiosks allow patients to interact with physicians through videoconferencing software and interactive medical devices. As part of its statewide rollout, HealthSpot connects patients with physicians from Cleveland Clinic, University Hospitals and Kettering Health Network in the Dayton area.
Also, last week in Parma Heights, The MetroHealth System opened its first clinic staffed by a nurse practitioner within a Discount Drug Mart store. The health system plans to open four more in Cuyahoga County by year’s end, with the possibility for even more beyond that. The parties are in talks about extending the Medina-based retail chain’s relationship with the health system beyond Cuyahoga County, according to Discount Drug Mart chief operating officer Doug Boodjeh.
Across the country, there are 1,800-plus retail clinic locations, according to a recent report from Manatt Health, a national health care consulting firm. Still, according to the study, that represents only a sliver — about 2% — of all primary care encounters. That said, local health care officials stress that this isn’t a fad considering many of the patients that use retail clinics don’t have a designated primary care physician.
MetroHealth CEO Dr. Akram Boutros said the clinics are a “permanent part of the health care system.”
“This is a way of engaging these patients early on in their health care journey,” he said.
It’s tough business
While the retail clinic industry is a relatively young one, it’s not terribly easy to break into.
CVS’ Minute Clinic, for instance, is by far the largest provider of retail-based health care, with more than 900 locations across the country. The Cleveland Clinic, meanwhile, has had an arrangement with the drugstore chain since 2009, and today its docs serve as the medical directors for 26 of its clinics in Northeast Ohio.
Giant Eagle made a concerted effort to get into the health care space a few years back, but it has halted those efforts. The Pittsburgh-based grocery chain had forged arrangements with UH and Summa Health System in Akron to open so-called FastCare clinics in cities such as Lyndhurst, South Euclid and Wadsworth. All of those locations have since closed, though Giant Eagle still operates one FastCare clinic in the Columbus area.
“We continue to evaluate numerous opportunities to deliver a strong overall health and wellness experience for our customers,” said Dan Donovan, Giant Eagle’s marketing manager, in an email. “While customer acceptance of this clinic is high, we do not currently have plans for additional locations.”
When asked about the relationship with Giant Eagle, a UH spokesperson said those locations closed due to low volume. A Summa spokesperson said the model “didn’t make sense for us any longer.”
MetroHealth’s Boutros, however, doesn’t seem fazed by the spirited competition in the retail space. As he sees it, the MetroHealth outposts at Discount Drug Marts are a “way of engaging these patients early on in their health care journey.”
He said the staff won’t just be working on an episodic basis but also doing pro-active follow-up to ensure the patients visiting the clinics are recovering and following care instructions. They’ll also be part of the system’s electronic medical record.
“We have been in a very deliberate way looking at population health and the role of the retail market in managing the population,” Boutros said.
By integrating its retail outposts with the rest of the health system, Boutros said MetroHealth will be sidestepping what has become the largest criticism of the health care industry — the fragmentation of health care. Industry groups have chastised the retail health care industry for working outside the parameters of local health care delivery systems. Retail clinics might be convenient, but if that care isn’t coordinated or communicated in some way with a patient’s primary care physician, complications could occur.
That’s part of the reason major retail chains like CVS and Walgreens are collaborating with health systems as they open new clinics. Over the last five years or so, the Clinic’s relationship with CVS has evolved to a point where they’re electronically sharing patient records. When it started, the Minute Clinic’s staff were faxing over patient notes.
“We know there’s a segment of the population that loves the convenience of Minute Clinics, but we want to know what’s going on and what’s exactly happening with these patients,” said Dr. Michael Rabovsky, chairman of the Clinic’s department of family medicine. He added that the Clinic and CVS are in talks about how to expand the relationship even further, though he couldn’t get into details.
HealthSpot’s entrance into the market has been perhaps the most intriguing development on the retail health care front.
All of the Cleveland-based health systems have been piloting the kiosks, but the Rite Aid deal facilitated the first major push by HealthSpot to get its technology in front of consumers. Over the next six months, the company plans to put 50 to 100 more of its kiosks at Rite Aids in Ohio and beyond.
The goal, according to CEO Steve Cashman, is to make HealthSpot as common as Redbox — the automated movie rental kiosks at grocery stores and convenience stores.
The biggest challenge to its growth, he said, is customer awareness. After all, walking into a giant box and chatting with a doc through a monitor isn’t your average health care encounter. But don’t knock it until you try, he said. “You didn’t use Uber until you tried Uber,” said Cashman, referring to the popular ride-sharing app. “There’s definitely a customer-awareness issue.”
Retailers have spent billions of dollars trying to get into the health care space, but Cashman argues that the traditional model — quaint offices within drugstores — is too expensive. It costs significant dollars to build out and staff a space whereas the HealthSpot kiosks carry an upfront cost of about $10,000 to $15,000 apiece.
“We’re shovel-ready with very low overhead,” Cashman said. “We’re low-cost out of the gate and can scale very quickly.”
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