From retail clinics to virtual care, a natural evolution in the patient access to care crisis


As a family physician, father of two, and the medical founder of the retail clinic model and the founder of MinuteClinic, patient access-related issues have been near and dear to me for almost two decades now.

The development of the retail clinic model was spurred by the inability for patients to access care conveniently and in a timely manner for very common, relatively simple, everyday ailments that required very little infrastructure or elaborate diagnostics to treat.

Our initial model was based even more simply on the idea that many patients are truly only looking for the answer to the question, “Do I need an antibiotic or not?” (to treat whatever was going on with them). 

The early retail clinics had a very limited scope of practice and relied heavily on the on-site quick labs for objective answers to these basic questions. As the model matured, additional services and products were added, such as vaccines, sports physicals and additional diagnoses, with the idea that we would continue to limit the scope due to the constraints of space, provider licensure, education and experience, as well as the ability to gain ancillary information. 

This addition to the provider world was widely embraced by patients and payers -- but initially panned by providers. However, over time not only patients and payers, but also the provider community, has embraced this concept of convenient care. I now have colleagues who admit that they recommend that their patients go to a retail clinic if they are calling in to be seen for a simple problem and are not able to be seen in their primary clinic setting. Nonetheless, there are of course still problems with this model.

The overall utilization of retail clinics has suffered from the need for a physical interaction between the patient and provider. It would be cost-prohibitive to provide a retail clinic in every pharmacy/drug store chain and would be a very poor business model. The logical next step is to look at delivering care virtually and remotely. 

Even in the early days of the retail clinics, patients had already made the leap, intellectually, into the world of virtual delivery of care. Many of my own patients, when they knew I was involved with MinuteClinic, would ask why they couldn’t just call in rather than have to take time off work, wait in my waiting room and lose a half a day for a simple problem. 

While telemedicine in the form of doctor-to-doctor and “hub-and-spoke” delivery to rural and remote locations has been done for more than 25 years, the idea of patient-to-doctor delivery of care remotely and virtually has been difficult, at least in part, secondary to technological shortcomings. 

As technology has improved, from telephone to e-mail to smartphones and video conferencing, the utility of remote medical consultations has moved from a very small, niche, high-cost, hardware-intensive delivery system, to a mobile, low-cost, easily accessible and widely available system.
 
Doctors and patients have been consulting via telephone for decades. Both parties are very comfortable with this model which has helped spur rapid acceptance among both patients and physicians of consumer-directed virtual care/telemedicine solutions. 

I will spend the next several blogs looking at the rise and development of virtual care medical solutions from all perspectives — patients, payer and provider — and discuss the opportunities and pitfalls in all areas.