Retail clinics gain ground in Ozarks, U.S.

With the June 13 opening of a clinic inside the Walmart Supercenter at 2825 N. Kansas Expressway, there are now five CoxHealth-operated locations of The Clinic at Walmart in the Ozarks.

CoxHealth entered the retail-based-clinic arena in March 2009, unveiling The Clinic at Walmart at 3315 S. Campbell Ave.

While The Clinic at Walmart may have introduced retail-based health care to the Ozarks, retail pharmacy chains CVS and Walgreens have operated in-store clinics – MinuteClinics and Take Care Clinics, respectively – since 2000, said Tom Charland, CEO of Merchant Medicine, a Minneapolis-based health care consulting firm. In the beginning, retailers overbuilt the walk-in clinics, but by about 2008, they began reducing the number of clinics, typically positioning them only in the 50 largest U.S. cities, Charland said.

Walmart’s approach is to partner with local health care providers and allow them to operate the clinics within the stores, said David Taylor, vice president of regional services for CoxHealth.

“It’s been a great partnership for us,” Taylor said. “With this arrangement, you get access to the Wal-Mart name, but everybody is an independent operator.”

Calls to Wal-Mart’s corporate office for more information were not returned by press time, but officials have indicated that the partnership with CoxHealth has been beneficial to the retailer, too.

“Wal-Mart is dedicated to serving our customers and our communities, and this type of clinic helps expand their access to quality health care,” said Bruce Shepard, Wal-Mart’s director of health care innovations, in a news release.

Retail care competition
Charland said Mercy, which owns St. John’s Health System in Springfield, operates Wal-Mart clinics in Oklahoma. He noted that working with local providers is just one way Wal-Mart’s approach to retail-based care differs. Another is that Wal-Mart is adding clinics in smaller markets such as Springfield.

Wal-Mart in 2007 announced its plans to contract with local hospitals and providers to put health clinics in as many as 400 of its stores, with projections of up to 2,000 in-store clinics by 2014, depending on market conditions.

“CoxHealth is a very positive story for Wal-Mart. They’ve got five of these clinics and are having good success with them,” Charland said.

Though he declined to disclose exact patient counts, Taylor said CoxHealth’s retail clinics see thousands of patients a year.

While both CVS and Walgreens operate locations in Springfield, neither have any area retail clinics. Madeline LeFave, a spokeswoman for Rhode Island-based CVS, said the retailer has not announced any plans to open MinuteClinics locations in either of its two Springfield stores. A Walgreens representative could not be reached by press time.

Overall, retail clinics, including The Clinic at Walmart, are designed to treat nonemergency ailments such as upper respiratory infections, minor injuries and other nonlife-threatening health concerns.

“Of all the illnesses we treat, the top 10 or 15 are all respiratory,” Taylor said.

Caregiver connections
The Clinic at Walmart sites are staffed by nurse practitioners who review patients’ concerns and can write prescriptions as needed or recommend courses of treatment. But for CoxHealth, the clinics also can serve as a starting point to connecting patients who don’t have primary care physicians with a primary care doctor at CoxHealth or one of its affiliates.

After seeing a nurse practitioner at the clinic, patients who don’t have doctors are referred to a primary care physician for follow-up care, Taylor said.

The Walmart-based clinics also are designed with lower costs in mind, making retail-based care more affordable and accessible to those who have no insurance or are underinsured. Fees start at $25 for a flu shot and $65 to treat common illnesses such as respiratory infections.

One of the goals of opening the clinics was to take some of the burden off urgent care and emergency rooms. The Wal-Mart clinics seem to be filling some of that need, Taylor said, with fewer patients presenting with less severe illnesses or injuries in the emergency room setting.

“Our doctors in the emergency rooms report the acuity is higher since the clinics have opened,” Taylor said. He noted that since the retail clinics opened, emergency and urgent care visits have dropped slightly.

Growth potential
In addition to the Kansas Expressway and Campbell Avenue sites, The Clinic at Walmart locations also are at 2021 E. Independence St. in Springfield, and at the supercenters in Ozark and Republic.

A location in Branson opened in November 2009 through a partnership between CoxHealth and Skaggs Regional Medical Center but closed in December 2010.

“In Branson, we didn’t experience the volume we have in other markets,” Taylor said. “It just never took off.”

CoxHealth officials say there is still room to grow the health system’s retail presence. CoxHealth can add new clinic locations in Walmart Supercenters within the 22-county area it serves surrounding Springfield.

One of the critical components of opening the clinics is finding nurse practitioners to staff them. Each clinic typically employs two full-time and one part-time nurse practitioners. Through Cox College, CoxHealth has access to new nurse practitioners.

Though CoxHealth’s retail clinic model is expanding in the Ozarks, Merchant Medicine’s Charland said retail clinics still comprise just a small portion of U.S. health care. He estimates that of the dollars spent overall on health care, retail clinics represent  “something like two-hundredths of a percent.”

He expects that number to grow, however, with Walmart’s independent contractor model and the in-house approach of CVS and Walgreens.

“I think they’ll both be successful,” Charland said. “The experience is not all that different to the consumer.”[[In-content Ad]]