Retail Clinics and Usual Primary Care: Both Respond to Rising Numbers of Unemployed the Same Way

If you, like the Disease Management Care Blog, take the time to read Managed Care Magazine, you already know a lot about Clayton Christensen's view that Retail Clinics are a disruptive innovation in healthcare. Maybe they are, but the DMCB was reminded today of just how similar that business is to 'usual' physician-based outpatient primary care.

Today there was a news release on how Walgreen's Take Care Clinics will be offering free acute care services to persons who can prove they are unemployed and show up between the hours of 11 AM and 3 PM. Remarkable you say? Give them a Gold Star for being socially conscious you say?

Not really. Before the news release described above, the DMCB recently broke bread with some community based primary care physicians and chatted about the bad economy and its impact on their practices. All three physicians described how many patients with 'good' insurance were a) losing their jobs, switching into COBRA and using their insurance to 'catch up' on all that previously foregone testing while it was still covered, b) going onto the Medicaid rolls or c) becoming uninsured. The DMCB asked if the docs were tempted to 'drop' the patients without good insurance from their practices. Their response was not surprising, when you think about it.

The answer was 'no.' All three physicians were seasoned businessmen who had been through previous economic downturns. They had seen this before. Today's patients with no or non-remunerative insurance were not only yesterday's richly insured but tomorrow's also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured. By the way, continuing to care for these patients is the right thing to do, but from a business perspective, this is a loss-leader and an investment in the future. In contrast to Walgreens, there are no press releases.

Press releases aside, the same business logic applies to Walgreen's Take Care. Like the usual primary care providers the DMCB spoke to, Walgreen's is interested in serving today's uninsured, because tomorrow they'll be paying patients who will appreciate what Walgreen's has done for them. The positive word of mouth will help, there will be good press and lastly, while at Walgreens, these patients are likely to buy prescription and over-the-counter meds and while they're at it, print out some photos and pick up some diapers (and, by the way, hopefully NOT be tempted to buy any tobacco products). This is shrewd business sense in the field of primary care. It wasn't discovered by Walgreens.

The DMCB wonders if, with time, the stark differences between Retail Clinics (nurse practitioners using decision support with health information technology to treat common medical conditions) and usual primary care (which will use decision support with HIT to intelligently manage most medical conditions) will fade away. The response of both to the rising numbers of unemployed makes the DMCB wonder if there are more similarities than we've suspected.

"Disruptive?" Maybe not.