COVER STORY

CLINICS, CLINICS,
EVERYWHERE
They are all the rage—thousands of retail-based health centers
are set to open this year. Should you open one?

Sandra Levy in an in-store-clinic catfight. In July, CVS Corp., one of

the players that was early to the game, gained a

I
t’s noon at the Duane Reade pharmacy in the heart foothold by acquiring Minneapolis-based Minute-
of Manhattan on Broadway and 50th Street. In Clinic. With 118 clinics in 17 states, the chain plans a
walks a middle-aged broad national expansion.
man seeking a flu shot The California Health-
from the pharmacy’s in- Care Foundation (CHCF)
store clinic. He walks over projects that, over the next
to a desk manned by a few years, thousands of
medical assistant and a retail clinics will open
nurse practitioner (NP) in chain pharmacies and
on the second floor. He is large retailers across the
taken into an exam room country. Retail chains are
and within minutes re- also aligning themselves
ceives the immunization. with hospital systems to
He pays a modest fee and bring clinics to patients.
exits the store. Some physicians, too, are
That scene is being getting in on the act,
played out daily in about launching clinics of their
300 in-store clinics nation- Take Care operates in-store clinics in Walgreens and Eckerd. own. And corporations are
wide, in which pharmacy opening work-site clinics.
chains, supermarkets, and large retail stores are offering What’s behind the in-store clinic boom? Is it a fad or
convenient access to low-cost health care and services. is it a trend that’s here to stay?
No doubt about it. Pharmacy and retail chains are With healthcare costs soaring and an estimated 46 mil-

Top clinic players

AtlantiCare HealthRite: Express Clinics: My Healthy Access:
www.atlanticare.org/ www.express-clinics.com www.healthyaccess.com
healthservices/healthrite.php HealthStop: QuickClinic:
Aurora QuickCare: www.healthstopclinic.com www.quickclinic.com
www.aurorahealthcare.org/
Lindora Health Clinic: QuickHealth:
services/quickcare/index.asp
www.lindora.com www.quickhealth.com
CareClinic: No Web site
MedBasics: RediClinic InterFit Health:
CareWorks Convenient Healthcare
www.med-basics.com www.rediclinic.com
Geisinger Health System:
www.careworkshealth.com Medpoint Express Memorial Hospital Sutter Express Care Sutter Health:
CheckUps: and Health System: www.sutterhealth.org/
www.checkupsusa.com www.medpointexpress.com sutterexpresscare
Early Solutions Clinic: MinuteClinic: Take Care Health Systems:
www.earlysolutionsclinic.net www.minuteclinic.com www.takecarehealth.com

50 DRUG TOPICS FEBRUARY 5 2007 www.drugtopics.com

lion Americans uninsured, the concept of health care to their employees. Not only are the
launching an in-store clinic appears to be a clinics a relatively cheap way for employers to
win/win situation for retailers and patients. DT provide health care compared with other delivery
While it is early in the game to give precise CAPSULES options, but they could reduce absenteeism for
figures, in-store clinics can have a positive im- Thousands doctor’s visits because employees could be treat-
pact on pharmacy’s bottom line. Speaking at of retail ed for minor conditions within the workplace.”
the Food Marketing Institute’s (FMI) annual clinics are
supermarket pharmacy conference last April, set to open Consumers willing to try clinics
Randy Heiser, R.Ph., VP, pharmacy, Giant According to a recent Wall Street Journal On-
over the
Eagle, told a packed room that clinics have the line/Harris Interactive Health-Care Poll, pa-
next few
potential to increase Rx and OTC sales, new tients appear to be willing to try in-store clinics.
pharmacy and grocery shopping customers, years. The poll was conducted among 2,245 adults,
and patient satisfaction. In addition they help to ages 18 and over.
provide a point of difference for the retailer. To Eighty-three percent of adults who responded
give attendees an example of the economic po- to the poll strongly or somewhat agree that on-
tential of adding a clinic, he said an in-store clinic can site health clinics at retail stores can provide basic med-
serve four patients an hour—48 people a day. ical services to people at times when doctors’ offices are
“Ninety percent of people seen at the clinic receive a closed, such as evenings and weekends. Seventy-eight
prescription; 85% of people seen at the clinic end up us- percent strongly or somewhat agree that on-site health
ing that pharmacy to fill the prescription; patients leave clinics provide busy people with a fast and easy way to
with 1.2 prescriptions in their hand; 65% of people in get basic medical services. Seventy-five percent of re-
the store are brand-new customers as a result of coming spondents strongly or somewhat agree that on-site
to the clinic,” said Heiser. health clinics can provide low-cost basic services to peo-
Staffed primarily by NPs, these clinics offer conven- ple who otherwise might not be able to afford care.
ience to patients seeking medical treatment for common These statistics are music to clinic operators’ ears.
illnesses such as sore throats, coughs, colds, earaches, “The clinics are certainly here to stay. Everything is
and respiratory infections. Most of the clinics are open leading in this direction,” declared Hal Rosenbluth, co-
seven days a week; therefore, their hours are more con- founder and chairman of Take Care Health Systems,
venient than those of a traditional doctor. which operates Take Care clinics.
The clinics generally see patients 18 months of age Noting that the company’s plans for 2007 are to open
and older, and visits generally take 15 to 25 minutes for on average one new clinic every business day, Rosen-
diagnosis and treatment. The basic cost for a visit ranges bluth said that his company conducted extensive re-
from $40 to $70. Many insurance plans cover visits to search on the concept. Using a national research firm
these clinics and allow the patient to pay only a co-pay. called AccuPoll, Take Care said the concept received one
Mary Kate Scott, principal of the strategy consulting of the highest scores among consumers in recent years.
firm Scott & Co. and adjunct profes- Take Care operates a total of 36
sor at the University of Southern in-store clinics. They are located in
California’s Marshall School of Walgreens in Chicago, St. Louis,
Business, authored a report on retail and Kansas City and in Eckerd in
clinics for CHCF. In the report, Pittsburgh. Last month, Take Care
“Health Care in the Express Lane: opened its first on-site location in
The Emergence of Retail Clinics,” an undisclosed corporation.
she noted that retailers generally see Rosenbluth cited the following
two ways to gain from in-store clin- factors that he believes will contin-
ics. “On the revenue side, they hope ue to drive the proliferation of in-
the clinics will attract new custom- store clinics: a decline in the num-
ers and drive sales elsewhere in the ber of primary care physicians; a
store, especially prescription and large percentage of Americans who
Photo: Sandra Levy

over-the-counter purchases,” she don’t have a primary care provider;

said. “On the cost-savings side, and the high cost of health care for
some retailers see an opportunity to companies and for uninsured pa-
manage the expense of providing Duane Reade has aligned with RediClinic. tients. “All of these factors point to-

www.drugtopics.com DRUG TOPICS FEBRUARY 5 2007 51

 COVER STORY

ward a new strategy in healthcare delivery,” ic plunge. Agnese cautioned that the introduction of
he said. “These clinics are filling a gap and this new service could present a number of execution
they are solving a problem that will only get risks for pharmacies, including staffing NPs for the clin-
worse as time goes on.” ics, potential malpractice liability, and redesigning
Retailers According to Anny Eusebio, clinic manag- stores to include space for the new clinics.
hope that er and certified family NP at Duane Reade’s Another issue to be reckoned with is ensuring that the
clinics will RediClinic in New York City, business has clinics provide quality care. To this end, about 16 retail
drive OTC been robust. By the first week in November clinic companies have joined in a newly formed trade as-
2006, she had administered 100 flu shots and sociation called the Convenient Care Association (CCA).
and Rx
had treated a large number of patients for Initially, CCA will focus on establishing quality care
sales. throat infections and standards by partnering with oth-
sinus problems. She er healthcare leaders and industry
reported that patients associations. The association also
like the convenience of plans to communicate the services
using the clinic. “They are seen for available and the quality of profes-
15 minutes and they go back to sionals delivering these services. A
work. We are seeing a lot of repeat common marketing and branding
customers. At first, 90% of our approach will be developed and
business came from travelers. implemented. In addition, CCA
Now it’s 50-50. We’re starting to will establish a collective policy
see locals come in to be treated and agenda to outline regulatory op-
we’re starting to see more patients portunities and ensure the success
being referred by friends.” of the industry.
Eusebio also reported that hav- “The convenient care industry
ing an in-store clinic is a potential has revolutionized the way pa-
boon to Duane Reade’s prescrip- tients access health care. That kind
tion and OTC sales. While pa- of impact is energizing, and it
tients are free to fill their med- brings a lot of responsibility with
ications and buy their OTCs it,” said Tine Hansen-Turton, exec-
wherever they choose, she ac- utive director of CCA.
MinuteClinic, owned by CVS,
knowledged, “If you are here, ob- has 118 clinics in 17 states.
Take Care’s Rosenbluth, who is
viously you’ll check it out. It ends president of CCA, added, “The as-
up happening by default. It’s part of the attraction of sociation is creating quality standards for everybody to
the clinic. You are staring at cough drops that are dis- follow. We all think that is critically important.”
played right in front of you.”
Standard & Poor’s Equity Research Services agreed Advice for pharmacies
that pharmacies’ decision to roll out in-store clinics could What do you need to know before jumping on the clin-
be a “potential earnings driver.” ic bandwagon? Hansen-Turton advised, “You have to
Joseph Agnese, senior industry analyst at Standard & have the right space in your pharmacy and know what
Poor’s in New York City, said, “Given that 30% of the the costs are. Having office volume to attract enough
U.S. population doesn’t have a primary care physician patients to the clinics is another important concern.”
or the time to visit one, in-store clinics represent a po- Jeff Gross, director of MinuteClinic Expansion and
tentially viable and lucrative service offering. Pharma- Integration for CVS/Pharmacy, believes that the space
cies believe this service will lead to increased prescrip- devoted to a clinic need not exceed 80 to 140 sq. ft. “The
tion sales, and, more important, increased sales of whole idea is, let’s not overbuild this. Let’s not ov-
higher-margin, front-end items. Additionally, most in- erengineer. In your pharmacy every square foot is pre-
surance companies have said they will cover the service cious and you want to make sure that you are using it
charges for the in-store clinics.” efficiently.”
Hansen-Turton pointed out that it is important for
Challenges ahead pharmacists to understand the regulatory environment
Despite the potential benefits for pharmacies, there are in which they operate. “Most of the clinics have NPs
several challenges for those considering taking the clin- who are regulated at the state level,” she said. “In some

52 DRUG TOPICS FEBRUARY 5 2007 www.drugtopics.com

COVER STORY
Many pediatricians are
states, NPs have to have a collabora- Lindora Health Clinics have recently
opposed to retail-based clinics.
tive relationship with a physician, opened in three Rite Aid stores in
and in other states they have to have a Orange County, Calif.
supervisory relationship with a physician.” Duane Reade has signed an exclusive agreement
Gross advised that when determining whether to use with North Carolina-based Laboratory Corp. of Ameri-
an NP or physician assistant (PA), it’s important to ask, ca Holdings (LabCorp), a large medical testing labora-
Who has more liberal abilities to diagnose within the tory, to open 20 patient service centers in its stores. The
scope of services and to write prescriptions? “In most patient service centers will be operated by trained Lab-
states, nurse practitioners have a broader ability to write Corp staff in private rooms designed for performing
prescriptions than the physician assistants,” he said. these services.
Pharmacies can try to lead the retail pack by inquiring Jerry Ray, senior VP of pharmacy operations with
whether the clinic partner uses proprietary software. Duane Reade, said, “With the LabCorp patient service
Gross explained that MinuteClinic utilizes software that centers, Duane Reade will be able to offer its customers
guides NPs in determining whether it is appropriate to quick access to a comprehensive menu of diagnostic
see a particular patient or if the patient should be re- tests, as well as all their pharmacy, OTC, and personal
ferred to a physician. He gave the example of a patient shopping items—all in the same convenient location.”
who comes in with strep throat, who also has diabetes, Another recommendation for success is to post prices
congestive heart failure, and elevated cholesterol. for the services offered. “Transparency is the buzzword.
MinuteClinic’s proprietary software demands that the People ought to understand what the services cost,” as-
NP refer this patient back to his or her physician. serted Gross.
Retailers and pharmacies interested in setting up a Gross also insisted that a successful clinic model de-
clinic should also find out the clinic partner’s adver- pends on the clinic’s participation in health insurance
tising and marketing plans and the amount it is will- plans, including government plans. “Not all competi-
ing to allocate for advertis- tors are doing that. They are looking at this as cash-
ing and marketing. “We and-carry services. I question whether, in the long
believe very strongly in term, patients will continue to pay $60 for a visit if
a mass-media approach,” they can visit a doctor for a $20 co-pay,” he said.
said Rosenbluth. “We ad- According to the CHCF report, about 40% of clin-
vertise heavily on TV, ra- ics do accept insurance.
dio, and in print.” Retailers may also want
Another tactic for to inquire whether or not
trumping the competition the clinic operator has re-
in the clinic arena is to ceived accreditation or in-
partner with a clinic that stituted any programs for
pays special attention to quality assurance.
offering patients a conven- In October 2006, Minute-
ient experience. For in- Clinic received accredita-
stance, at Take Care, pa- Weis Markets has teamed up with Geisinger tion from the Joint Commis-
Health System to open CareWorks clinics.
tients register by using a sion. Gross said, “We need
touch screen similar to those used in airports for elec- to make sure that quality is basically ensured and having
tronic ticketing. When patients register, an electronic a good outside seal of approval is one way to do that.”
medical record is created. The clinics’ centers are net- Take Care Health Systems announced that Charles
worked so that patients can go to any center in any Peck, M.D., will be joining its executive level team as
state and access their health record. chief medical officer. He was previously a regional
Take Care also uses electronic scripting so that pre- healthcare delivery president with Aetna and will play
scriptions can be sent to any pharmacy. a major role in expansion and new strategic initiatives
Yet another consideration for pharmacies and retail- for Take Care in 2007, as well as validating quality of
ers is whether the clinic partner offers any unique serv- service and outcomes.
ices that will help them outpace their competitors. Pharmacies opening clinics may also benefit by
Rite Aid has teamed up with Lindora, a firm that hooking up with a company that partners with em-
is recognized for its medically supervised weight- ployers. “We partner with large employers, and, in
management programs in southern California. The some cases, we put clinics in office buildings to make

www.drugtopics.com DRUG TOPICS FEBRUARY 5 2007 53

COVER STORY

them accessible for the employees,” said Gross. “This nosis without proper follow-up, and public
breeds familiarity with the clinics when employees health issues surrounding exposure to con-
start to see them in their community.” tagious diseases in a retail environment. Pharmacies
Finally, pharmacies may want to partner with a clin- Since it does acknowledge that these clinics should try
ic that has a relationship with the medical community. will likely continue to exist, AAP has issued to gain
Gross revealed that MinuteClinic sends letters of intro- a set of guidelines. The complete policy
the support
duction to physicians whenever it enters a new market. statement is available at www.aap.org.
of local
The result has been beneficial. “Some medical special- In Scott’s report on clinics, she addressed
ties actually encourage patients to use MinuteClinic the concerns of primary care physicians, physicians.
when they are closed,” he said. stating, physicians “have expressed con-
cerns about quality and continuity of care,
Resistance from physicians especially in handling patients with serious
Although opening an in-store clinic may seem like or chronic conditions. People with chronic conditions
a no-brainer, before you follow through with your are theoretically attractive to retailers and clinic compa-
plans, beware: You are likely to encounter opposition nies—they are potentially very profitable repeat cus-
from physicians. tomers—but critics are quick to point out that clinics are
In September 2006, the American Academy of Pedi- not set up to function as a ‘medical home’ for patients
atrics (AAP) issued a new policy statement opposing the with chronic diseases. In response to these concerns, the
use of retail-based clinics (RBCs). “These clinics do not clinic operators have been firm about their limited
support AAP’s commitment to the medical home model scope of practice.”
that provides accessible, family-centered, comprehen- Gross acknowledged that pharmacies and retailers
sive, continuous, coordinated, compassionate, and cul- should be prepared to face objections from local physi-
turally effective care for which the pediatrician shares re- cians in their area. “When we first partnered with Min-
sponsibility with the family,” said the statement. uteClinic, doctors in Rhode Island weren’t happy, and
The academy is particularly concerned with the fol- they called me a lot,” he said. “One pediatrician said,
lowing: fragmentation and possible lower quality of ‘We expanded our call hours, we’re open nights and
care, care for children with special healthcare needs, lack weekends, and now you are coming in.’ The reality is
of access to a central health record, use of tests and diag- that most physician offices haven’t made the invest-
ment in those kinds of service availabili-
ties. Patients are saying they need to be
Retailers early to the clinic game seen after-hours. It’s well established that
• CVS/MinuteClinic we’ve worked so hard on those service
• Kerr Drug/SmartCare Centers levels in pharmacy that we have a great
• Walgreens/Take Care Health’s Health Corner Clinics/InterFit Health lead on our physician counterparts when
(RediClinic) it comes to extended hours.”
• Rite Aid/Sutter Health’s Express Care clinics/Lindora Health Clinics To physician critics who complain that
• DuaneReade/RediClinic the clinics are skimming the easy patients
off the top, Gross responded, “It’s hard to
• Medicine Shoppe and Medicap Pharmacy/MindGent Healthcare
Clinics’ Classic Care Clinics come up with a response other than, ‘That’s
true.’ But consumers are looking for more
• Winn-Dixie/Wellspot Medical Clinics
of a choice. If you have kids, the emergency
• Cardinal Health’s Leader/MindGent Corner Care Clinic room is not a great solution and waiting un-
• Navarro Discount Pharmacies/Express Clinics til tomorrow is not a solution either.”
• Wal-Mart/Aurora Health Care’s Aurora QuickCare clinics In response to physicians who argue that
• Meijer/Early Solutions Clinic the clinics’ NPs may overlook a patient’s
• Publix Super Markets/The Little Clinic serious medical problem, Gross pointed
• Fred Meyer division of the Kroger Co./SmartCare Family Medical out that many physicians also hire NPs.
Centers Emphasizing that MinuteClinic and oth-
• Wal-Mart/SmartCare Family Medical Centers er retail clinics don’t want patients to use re-
• Carnival Supermarket/MedXpress Clinic tail clinics as their medical home, Gross said
• Sedano’s Pharmacy/Continucare’s Valueclinic the NPs at clinics like MinuteClinic fre-
quently refer patients to their physicians.

54 DRUG TOPICS FEBRUARY 5 2007 www.drugtopics.com

COVER STORY
“That referral is driven by the proprietary
software program we use,” he said.
In-store Rosenbluth echoed Gross’ sentiments.
clinics “We believe strongly in the medical
represent home as do CVS and MinuteClinic,” he
a viable said. “Some physicians do initially think
and the clinics are a threat. They are not.
lucrative More people are brought into the system
service through these clinics than would be
offering. otherwise. We immediately refer people
back to their physician if something is
outside of our scope of practice. We’ll also
find them a primary care provider if they don’t have
one. It’s very much an integrated approach. We’re not
the final destination; we’re an entry point, and depend-
ing upon what the patients present with, we’ll get them
to the right care.”
CCA’s Hansen-Turton added, “The clinics are not re-
ally there to offset or become primary care providers.
They complement the existing primary healthcare net-
work and ambulatory and hospital network.”
At least one hospital has taken physicians’ com-
plaints seriously. St. Louis-based health system SSM
Health Care ended a deal with Take Care in which
SSM’s doctors supervised NPs at in-store clinics operat-
ing out of nine Walgreens stores in St. Louis. “Our deci-
sion is about listening to, and respecting, the concerns
of our physicians,” said a letter reportedly sent by CEO
Ronald J. Levy to the health system’s medical staff.
There are also physicians who are addressing the com-
petition from in-store clinics by fast becoming part of the
clinic craze. Two California doctors recently launched
Medi-Stop, which is like an in-store clinic with NPs and
PAs. The 1,200-sq. ft. Medi-Stop is located in a strip mall.
Hospital systems aren’t standing on the sidelines
either. In December, the Sutter Health network in part-
nership with Rite Aid opened its first Sutter Express Care
in-store medical clinic in a Rite Aid pharmacy in Nato-
mas, Calif. The clinic is one of six that will open this win-
ter in the greater Sacramento area.
Last June, Arcadia Resources, a national provider of
home care, staffing services, and respiratory and durable
medical equipment, announced it had formed a strategic
partnership with Physicians’ Organization of Western
Michigan (POWM), a 570-member independent physi-
cian coalition. Through POWM’s partnership with retail
supercenter Meijer, plans are moving forward to open
walk-in, routine medical clinics inside Meijer stores in In-
diana. Initial plans are to open nine walk-in healthcare
clinics in Meijer stores in Indiana over the next year.
In August, Geisinger Health System, a Pennsylvania-
based integrated hospital system with a large physician
56 DRUG TOPICS FEBRUARY 5 2007
medical practice and a large rural HMO, partnered with
Sunbury, Pa.-based Weis Markets to open CareWorks
clinics. There are currently two locations in Pennsylva-
nia. Weis has more than 150 stores in about six states
and plans call for expanding into those areas.
Dean Lin, VP of Geisinger Community Health Ser-
vices & Business Development and CEO of CareWorks
Convenient Care, said, “In Pennsylvania a lot of areas
we service are semirural and there is a shortage of doc-
tors. In these settings, having a medical clinic where peo-
ple go shopping that can serve a majority of their health-
care needs is an ideal solution. These clinics are here to
stay and grow, and that growth is going to accelerate.”
Noting that screenings and nutritional counseling will
be added to the grocery store’s in-store clinics’ offerings,
which already include laboratory services, Lin said that
when selecting a clinic partner, “it’s not just about the
short term and about adding more scripts or whatever
else. It’s really a long-term relationship where you want
to partner with someone who is here to stay and is a
driver for a successful business and is also able to create
good outcomes for the patient. You want patients to
have a good experience. That will be an important driv-
er in the long term.”
Looking into the crystal ball
What will the future hold? Hansen-Turton expects
that over the next few years there may be a shakeout
and some clinic companies may merge.
Rosenbluth predicted, “This
year will be a breakout year.”
Lin forecast, “It depends on
how fast hospitals are able to em-
brace and adopt this model. Once
they get their act together, it’s go-
ing to be pretty powerful.”
Finally Gross, who surmised
that clinics will add screenings,
coaching, counseling, health pro-
Hal Rosenbluth
motion, and disease manage-
ment to their menu of services, summed up the fu-
ture best when he said, “It’s important that the world
outside of pharmacy starts to look at pharmacy and
the industry as more healthcare oriented. The oppor-
tunity here, once these clinics become more preva-
lent, is that the pharmacy starts to be looked at as a
healthcare destination. Then you can leverage that
and become creative.” DT
For a look at the regulatory issues associated with
in-store clinics, go to www.drugtopics.com
and check out our Web Exclusives.
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