THE FUTURE OF CONVENIENT CARE

Pandemic-driven changes boost demand for clinics and reinforce their importance to the nation’s health-care system.

Retail health clinics including Kroger Health’s The Little Clinic, Walgreens’ VillageMD, and CVS’ MinuteClinic are emerging from the pandemic with enhanced technological capabilities, a growing array of services, and plans to expand their physical and virtual presences. Operators of these outlets are growing their telehealth offerings, enhancing their connectivity with other members of the health-care community, and adding more services that can help drive better outcomes for patients.

While clinic operators are hoping to return to many of their normal day-to-day routines in 2022, they are coping with ongoing staffing pressures amid widespread labor shortages coupled

with increased patient visits owing to COVID testing and vaccinations. Further, consumers have pent-up demand for medical services after postponing health-care activities during the pandemic, and many of those people are expected to turn to retail clinics for care in the year ahead.

Mental Health Services

In addition, clinic operators say they are preparing to face an increase in mental health issues such as depression and anxiety among their patients, brought on by isolation and other disruptions during the past two years.

Marc Watkins, MD, chief medical officer at Cincinnati-based Kroger Health, president of the Convenient Care Association, and member of the Convenient Care Clinician editorial advisory board, says that while vaccinations and testing will be significant areas of focus at The Little Clinic in 2022, the company will also strive to ensure that patients are aware of the clinics’ broad array of services, including mental health care.

“I think it’s important for us coming out of the pandemic to identify folks that may be struggling with things like anxiety, depression, stress — everyone’s experiencing some degree of that,” says Dr. Watkins.

Clive Fields, MD, chief medical officer and cofounder at VillageMD, which has a partnership with Walgreens and operates several clinics in the drug retailer’s stores, agrees that mental health issues will be a key area of focus in the year ahead. He cites the apparent impact of the pandemic on behavioral health, noting increased anxiety, depression, and loneliness, especially among seniors.

“It’s clearly an area where we plan on reinvesting in the integration of behavioral health and behavioral health services inside our community primary care locations,” Dr. Fields says.

At-a-Glance

• Retail health clinics are growing their telehealth offerings, enhancing their connectivity with other members of the health-care community, and adding more services.

• Clinic operators are preparing to face an increase in mental health issues.

• Retail clinic operators say they plan to continue to invest in remote health-care services.

Telehealth Expands in Retail Clinics

Telehealth emerged as an important element of clinical care during the pandemic, and retail clinic operators say they plan to continue to invest in remote healthcare services.

Angela Patterson, DNP, FNP-BC, NEA-BC, FAANP, vice president at CVS Health and chief nurse practitioner officer at its MinuteClinic subsidiary, says the increasing demand for virtual care during the pandemic led the company to launch a new telehealth service, E-Clinic, to complement its existing Video Visit platform. The company also accelerated the expansion of staffing and services for its virtual care offerings, which she says CVS plans to grow even more in 2022.

The company now employs nurse practitioners and physician assistants who deliver care solely via telehealth, as well as providers who deliver care both virtually and in its brick-and-mortar clinics. The combination of virtual and in-person care is a trend that bodes well for the retail clinic industry, says Dr. Patterson, who serves on the Convenient Care Clinician editorial advisory board.

“Now that patients are discovering the benefits and quality of virtual care delivery, there is an incredible opportunity for initial patient engagement through virtual care followed by in-clinic visits for testing, lab services, chronic disease monitoring, counseling, and more comprehensive wellness examinations,” Dr. Patterson says. In addition, she notes that “a good percentage” of CVS’ telehealth patients can be evaluated and given a prescription or care plan without the need for an in-clinic visit, which frees up the clinics for services that require in-person interaction.

VillageMD also seeks to unite its multiple platforms, including its brick-and-mortar offices, with onsite doctors and the comprehensive primary-care it offers through telehealth and remote patient monitoring under its Village at Home umbrella. “I think we’re seeing a move from the hospital as the center of health-care delivery to the primary-care office, but we’re seeing a primary-care office that is much different than the one that my father worked in during the ’80s and ’90s,” says Dr. Fields. “We’re seeing a primary-care doctor’s office that is advanced in terms of technology and analytics, has multiple platforms that can deliver care, and has an extension from the retail site into the home.” The company continues to expand the primary-care services it offers, as well as other ancillary diagnostic services. “Nobody likes to drive to the Texas Medical Center to have their blood pressure checked, and there’s really no reason that they should have to do that, with the technology we have now to bring the expertise of those medical centers into the communities where people work, live, and play,” says Dr. Fields.

which frees up the clinics for services that require in-person interaction.

VillageMD also seeks to unite its multiple platforms, including its brick-and-mortar offices, with onsite doctors and the comprehensive primary-care it offers through telehealth and remote patient monitoring under its Village at Home umbrella. “I think we’re seeing a move from the hospital as the center of health-care delivery to the primary-care office, but we’re seeing a primary-care office that is much different than the one that my father worked in during the ’80s and ’90s,” says Dr. Fields. “We’re seeing a primary-care doctor’s office that is advanced in terms of technology and analytics, has multiple platforms that can deliver care, and has an extension from the retail site into the home.” The company continues to expand the primary-care services it offers, as well as other ancillary diagnostic services. “Nobody likes to drive to the Texas Medical Center to have their blood pressure checked, and there’s really no reason that they should have to do that, with the technology we have now to bring the expertise of those medical

Clinics Connect with Other Providers

Dr. Watkins says The Little Clinic will focus on driving successful outcomes for patients in 2022 by ensuring that it plays an increasingly important role in the “continuum of care” among other health-care solutions in the communities where it operates.

“We would like to continue to collaborate in the space that is a multidisciplinary approach to care, coordinated with not only our pharmacies, but our health care partners around the country so that health-care is less fragmented,” he says.

That will involve taking steps to improve interoperability among health-care providers, Dr. Watkins explains, such as creating systems that better share records with patients’ primary care physicians, for example.

A key element of this effort revolves around closing gaps in patient care, he says. Clinicians may notice that a patient is in the age range for a specific type of cancer screening and discuss it with the patient, for example. This benefits the patient and ensures that clinicians are operating “at the top of their license,” he says, or performing value-added tasks beyond the routine services for which patients may have an immediate need.

The Little Clinic participates in the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), and Dr. Watkins says the company will focus on optimizing its potential through that initiative in the coming year.

Similarly, another important initiative for The Little Clinic in 2022 revolves around supporting primary care physicians’ efforts to conduct annual wellness checkups with their patients, which Watkins says helps relieve the strain on local doctors.

Optimizing Patient Care

VillageMD, meanwhile, also seeks to optimize patient care by leveraging technology to suggest services for patients. Its proprietary data analytics system, called docOS, collects patient data and uses it to segment patients according to risk and help optimize their care by suggesting appropriate testing, for example.

“It’s not about seeing more patients; it’s about seeing the same patients more often, because our data continue to show that the more touches a patient has with their primary care provider or primary care team, the better their ultimate outcomes, measured in terms of quality and total cost of care,” says Dr. Fields.

The VillageMD model for optimizing patient outcomes has been key to its success, he says, as is the integration of pharmacy services with its primary care offerings. The fact that the company’s pharmacy partners at Walgreens have access to VillageMD’s electronic medical records helps smooth communications between the two providers and ensures that patients, physicians, and pharmacists are all on the same page, Dr. Fields says.

Underserved Communities

The Little Clinic views its vast retail presence as part of the solution to providing health care to underserved communities, Dr. Watkins says. “We’ve seen primary care practices and urgent cares close and not reopen throughout the pandemic,” he adds. “We want to be part of the solution and get people into our doors to help them through whatever they need our assistance with.”

VillageMD is also focused on delivering care in underserved communities and communities with elderly and minority populations, says Dr. Fields. In fact, VillageMD has committed to opening half of its retail locations in underserved communities, he says.

In 2022, the company anticipates opening between 100 and 150 retail locations in both existing and new markets. VillageMD typically operates with two physicians, several clinicians, and other personnel, providing care in person and through technology to reach people in their homes.

The setting for these “pods” of care providers are “no longer 500 square feet, two plastic chairs, and a nurse practitioner,” says Dr. Fields. “Now it’s 3,000 to 5,000 square feet, 12 exam rooms, and a highly functional and technologically enabled office.”

Clinics Double Down on Convenience

In 2022, CVS’ MinuteClinic plans to enhance its practice model to provide more care for patients when and where it is convenient for them, Dr. Patterson says.

“We will be actively expanding our service offerings to become more primary-care-enabled, adding more than 50 new clinical services in a variety of areas, including mental health, women’s health, and sexual health,” she says. In addition, MinuteClinic is expanding its clinical care teams beyond nurse practitioners and physician assistants to create what Dr. Patterson describes as an integrated health care delivery team. This includes hiring registered nurses, licensed practical nurses, licensed vocational nurses, healthcare concierges, and social workers, as well as expanding its base of collaborating physicians.

“We are focused on developing an environment that enables our providers and nurses to practice to the top of their education and training to deliver quality care that makes a difference in our communities,” she says.

Staffing Challenges

Staffing remains a challenge for the entire industry, Dr. Patterson says. The strain of serving patients during the pandemic has led to fatigue and has impacted retention and hiring.

CVS’ MinuteClinic is seeking to overcome that challenge by offering “the benefits of a leading health care organization that is purpose-driven and deeply committed to supporting our providers’ needs,” Dr. Patterson says. The company also seeks to attract workers by offering career advancement opportunities in areas such as leadership and management, education, clinical trials, research, and mental health. C

Food as Medicine at Kroger

At Kroger, another initiative that has evolved during the pandemic is the company’s Food as Medicine program, through which the retailer’s registered dietitians help patients with diet-related initiatives such as creating tailored meal plans to address conditions including diabetes, chronic kidney disease, and obesity.

“We know that obesity is going to replace smoking as the No. 1 modifiable risk factor among all cancer risks,” says Marc Watkins, MD, chief medical officer at Kroger Health, “so we’re really doubling down with our clinics and our dietitians — creating and understanding and delivering solutions that help people live healthier lives. We’re going to lean on our internal teams at Kroger Health and The Little Clinic to really move that forward.”

The company will be encouraging conversations around nutrition with all of its patients, he says, leveraging Kroger’s status as the largest traditional supermarket chain in the country.

“We really want to win with food first,” says Dr. Watkins. “We think if we win with food, that also can be a benefit to the overall health of the populations that we serve.”