There have already been a number of significant developments in the “disruptive innovation” of retail medicine.  Its initial creation and rapid expansion have been noticed by all, and not always in a friendly way, with traditional medicine one of its biggest critics.  Attempts have been made to restrict or at least regulate such clinics, and some have closed down after not generating enough revenue and investor support.

Most recently, two developments have occurred:

1.    Major expansion plans, such as Wal-Mart’s plans to open 400 sites in the next 2-3 years and 2000 within the next 5-7 years, as announced at this year’s World Health Congress
2.    The “hosts” of such clinics becoming partial or total owners, as with Walgreen’s acquisition of TakeCare clinics, CVS’ acquisition of MinuteClinic, and Wal-Mart’s investment in RediClinics.

There is major synergy, even symbiosis between hosts and clinics.  The hosts gain added customers, when they come to the store for the purpose of getting health care, and buy either related purchases at the pharmacy, or use it for other shopping as well.  They also gain what is, in effect, a worksite clinic for their employees, saving time and expense compared to employees’ going to physicians’ offices or ERs elsewhere.

The clinics gain the added volume of traffic typical of their “superstore” or pharmacy hosts, and make it possible for their patients to enjoy one-stop-shopping convenience when prescriptions need to be filled, promoting compliance with such prescriptions when filling them is so easy, and often cheaper for patients as with Wal-Mart’s $4 generics.  They also gain the added convenience of any patients who cannot be seen immediately having something to do while they wait, without leaving the site, with some clinics offering pagers to waiting patients so they can shop and be notified when the clinician is available.

Another development that has been predicted is the addition of simple testing capabilities to the retail clinics.  By adding testing for blood sugar and cholesterol, for example, these clinics can make both going elsewhere for testing and waiting for results unnecessary.  Revenue from such tests, whether covered by insurance or paid for out-of pocket by patients, can add significantly to the revenue needed by the clinics to succeed, without adding significantly to the time it takes to serve patients. [B. Friedman “Wal-Mart to Open 400 In-Store Clinics” LabSoftNews.typepad.com May 14, 2007]

This development also fits well with one that is already underway – the inclusion of a wider range of preventive/proactive services aimed at enabling patients to better manage their health, rather than just get treatment for sickness.  Almost all clinics already offer simple physical exams, flu shots and other basic prevention.  But some are adding risk assessment and management services as well.

RediClinics, for example, have two different “service lines”, in “Get Well” sickness care, and “Stay Well” health management categories.  These added services create that many more opportunities to serve patients and generate added revenue, and can add volume to lab testing and other screening, when these are used to track progress toward wellness, not merely test for illness. (www.rediclinic.com)

RediClinics have also developed working relationships with traditional providers.  They rely on Memorial Hermann Health System and its medical staff physicians for medical oversight of clinics in the Houston, TX area.  They have also partnered with Bon Secours Health System in Richmond, VA.  And like Wal-Mart, they are planning a significant expansion, with over 500 locations envisioned that will include interactive media capabilities in addition to personal care providers.

The wellness element of retail clinic operations can offer new synergies for hosts, since there are a wide range of wellness-oriented products many already carry, or could easily add to inventory.  Pedometers for patients to use in tracking their walking or jogging efforts, personal blood pressure monitors, exercise equipment, scales, etc. could be “prescribed” by practitioners for their wellness patients.

Host stores could also become sites offering health measurement kiosks, such as Virgin Life’s “HealthZone” examples, which enable people working on wellness goals to measure their progress, with data downloaded to personal webpage sites, such as its “LifeZone” website. (www.virginlife.com)  These are self-service kiosks not requiring the services of practitioners, but could generate additional visits to host stores.

Since virtually every person in the U.S. has a health risk or concern that could become the motivation for wellness efforts, the market for the wellness side of retail clinic offerings would be enormously greater than that for convenient routine sickness care.  Already two authors have predicted that the “wellness” or “healthy living” market will reach $1 trillion in size in a few years [P. Pilzer The Wellness Revolution: How to Make a Fortune in the Next TRILLION DOLLAR Industry New York, NY, John Wiley & Sons 2002] or just over a decade [T. Haws “The New ‘Healthy Living’ Marketplace” Hospitals & Health Networks Online Jan 25, 2005].

The same synergies apply to wellness patients and host stores as is the case with retail sickness care.  Moreover, as is already true for worksite employer-sponsored clinics, they can become the source of wellness coaching and monitoring for employees at the host stores, in addition to their customers.  It is impossible to say at this stage how far into wellness retail clinics will move, but the RediClinic example is at least showing how it can be done.