Retail clinics - Walgreen-CVS Retail Clinic Battle

Since Regina Herzlinger officially launched the consumer-driven health care movement with a 1999 conference at Harvard Business school and a subsequent magnum opus book Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers (Jossey Bass, 2004), health policy experts and practitioners have debated: is consumer-driven care a myth or a reality? Congress poured gas on the debate by granting wide access to HSAs in December 2004. HSAs have grown to 6.1 million HSA holders, considered slow by critics and fast by proponents.

So the debate rages. Truth be told, health care is part consumer-driven, part provider-driven, and part government-driven. Genetic-disease, Acts-of-God diseases like cancer, sudden catastrophic events, or traumatic accidents do not lend themselves to consumerism. On the other hand, routine checkups and preventive visits, certain cosmetic surgeries, laser corrections for nearsightedness, elective surgeries to improve lifestyle, and minor mishaps and illnesses fit neatly in a consumer-driven mindset.

The best example of a consumer-driven phenomenon is the explosive growth of retail clinics, now numbering somewhere between 1000 and 1500. These clinics reflect the reality of consumer-yearning for less expensive, more convenient, and more predictable costs in neighborhood and mall outlets. Retail clinics are a prime example of “disruptive innovations,“ whereby consumers gain access to convenient less costly care provided by nurse practitioners rather than doctors (although a few clinics feature primary care physicians.)

It is ironic to me that the major battle for retail clinic turf is being fought in Boston, home of the Bean and the Cod, major academic centers, and the highest health premiums in the U.S. Perhaps because of the latter. Boston consumers backed the entry of CVS MinuteClinics into the Hub market. The Mayor and the academic establishment fought CVS but lost. This did not go unnoticed by the chief rival of CVS – Walgreens. Walgreens is now seeking state approval of 16 retail clinics in Massachusetts stores. All told by the end of 2008, CVS and Walgreens may have 1000 or so retail clinics in the U.S., and 40 or so in Boston and its suburbs.

Rapid growth of retail clinics is facilitated by consumer hunger for change, by retail advantages of one-stop health-prescription shopping, and by the Internet. Nurse practitioners has an EMR and electronic protocols to guide them to more standardized and predictable care. These electronic gismos are no substitute for clinic judgment, but they help. It is safe to predict that other “disruptive solutions, “ such as information technology directed self-care and home care and remote electronic monitoring of chronic disease will rapidly rise to the forefront of new medical technologies. Hold on to your hats. Medicine is now running on Internet time. I predict no miracles but anticipate profound change.