No matter what your profession, during social events talk turns to topics that are related to what you do. Lawyers are often engaged in conversation regarding legal topics, clergy often get cornered on religious topics, and nurses and physicians are often shanghaied into a conversation that has to do with someone’s health history. Since my family knows that I am a recent Healthcare management MBA, the topic I often encounter is the business of healthcare, or why does it cost so much. One such conversation occurred after Thanksgiving dinner, between my uncle, a retired businessman who survived a major health issue, my aunt who is a physician who works for the VA, and my brother who is a government employee. The discussion had many interesting points, (VA clinics vs. Medicare vs. Private Coverage, what people pay in vs. benefits received), but what struck me as the “aha” moment was when we started comparing notes on where we all got our flu shots. Gone are the days when you waited to make an appointment to get the vaccination from your doctor. Nowadays, you are just as likely to get them from a pharmacist or NP at a drugstore, as you are from your GP or internist. Cost is not a big driving factor, if one is covered by Medicare or private insurance (as we all were), the out of pocket cost is about the same. The driver of our choices of where to go, seemed to be convenience.
The Thanksgiving conversation seemed to mirror the findings of a Rand report that was released earlier in the week. A press release for the study noted a 10 fold increase in retail clinic usage between 2007 and 2009. (If the numbers ran to 2011 I’m sure there would be a greater increase). The RAND team used data from a commercially-insured population of 13.3 million lives. Of that number, close to a third (3.8 million enrollees) made at least one clinic visit between 2007 and 2009.
According to the press release, “The strongest predictor of retail clinic use was proximity. Other key predictors are gender (females were more likely to visit clinics than males), age (retail clinic patients tended to be between the ages of 18 and 44; those over 65 were excluded from the study), higher income (those from zip codes with median incomes of more than $59,000 were more likely to use retail clinics than lower income groups), and good health (those with a chronic health complaint were less likely to use retail clinics).”
“It appears that those with a higher income place more value on their time, and will use clinics for convenience if they have a simple health issue such as a sore throat or earache,” said Dr. Ateev Mehrotra, the study’s senior author and an investigator at RAND and the University of Pittsburgh.”
The trend for healthcare provisioning in alternate venues will only increase as more businesses realize the synergy of being in the clinical space. If the Rand report is correct, it shows those who value time will opt for convenience (retail clinics close to home), leaving sicker/poorer patients to use the higher priced options (clinics and E/R’s). While Wal-Mart back peddled on a rumored RFI to create a low cost integrated primary platform, (see here) make no mistake, it is looking at ways to increase its reach in the healthcare. According to a recent report in FierceMobile Wal-Mart (like Walgreens and others) is exploring many options, including mHealth applications. As these new players, with their deep pockets and consumer expertise, enter the clinical space, traditional players will need to adapt to keep profitable market share. Like the dinosaurs, size will not matter. Those who survive will understand the cultural shifts that have to start now, so that their organizations will be ready when this trend reaches critical mass. Don’t ignore the lesson of the independent drugstores. They used to be plentiful. But when was the last time you saw one of them?
Patching the Boat 