convenience care: youre sick. were quick. ¹ presented by stephen c. waldhoff, fache ¹minutecare,...
TRANSCRIPT
Convenience Care:Convenience Care: “You’re sick. We’re “You’re sick. We’re
quick.”quick.”¹¹
Presented byPresented by
Stephen C. Waldhoff, FACHEStephen C. Waldhoff, FACHE
¹MinuteCare, Michael Howe, CEO¹MinuteCare, Michael Howe, CEO
AcknowledgementsAcknowledgements
Albert Lea Medical Center – Albert Lea Medical Center – Mayo Health Mayo Health SystemSystem
– Karen Conn, Administrative AssistantKaren Conn, Administrative Assistant– Ginny Larson, Clinic AdministratorGinny Larson, Clinic Administrator– Steve Underdahl, Hospital AdministratorSteve Underdahl, Hospital Administrator
Michael Howe, CEO – MinuteClinicMichael Howe, CEO – MinuteClinic Charles Liedtke, Ph.D., University of MNCharles Liedtke, Ph.D., University of MN John Vollum, The Wellspring GroupJohn Vollum, The Wellspring Group
Background InformationBackground Information
Changing healthcare market Changing healthcare market conditionsconditions– Niche medicine movementNiche medicine movement– Consumer driven retail modelConsumer driven retail model
Retail medicine appealRetail medicine appeal– ConvenienceConvenience– CostCost– Appointment accessAppointment access
ObjectivesObjectives
IntroduceIntroduce and become familiar with the and become familiar with the concept of retail medicineconcept of retail medicine
UnderstandUnderstand the driving market forces the driving market forces behind convenience clinicsbehind convenience clinics
GainGain an appreciation for the impact this an appreciation for the impact this care model will create for traditional care model will create for traditional medicinemedicine
Suggest Suggest some potential take-home business some potential take-home business plan strategiesplan strategies
Assess Assess how one rural healthcare system is how one rural healthcare system is responding to retail medicine initiativesresponding to retail medicine initiatives
OverviewOverview
1.1. Concept DescriptionConcept Description
2.2. ImplicationsImplications
3.3. Potential StrategiesPotential Strategies
4.4. Albert Lea Medical Center (ALMC) Albert Lea Medical Center (ALMC) Express Care ModelExpress Care Model
5.5. QuestionsQuestions
Convenience Convenience CareCare
Concept DescriptionConcept Description
DefinitionDefinition
“A walk-in neighborhood medical clinic in retail locations where certified nurse practitioners diagnose and treat select common family illnesses using defined medical protocols.”
(PR Newswire US, 02-02-05)
OriginOrigin
Consumer driven conceptConsumer driven concept -- Convenience -- Accessible-- Convenience -- Accessible
-- Quick-- Quick -- Little or no out-of- -- Little or no out-of-pocket costpocket cost
-- Low Cost-- Low Cost -- Consumer empowerment -- Consumer empowerment
-- Simple-- Simple
Founded in 2000Founded in 2000 Minneapolis BasedMinneapolis Based
Origin Origin (cont.)(cont.)
MinuteClinic – early pioneer/founderMinuteClinic – early pioneer/founder– One physician and two investorsOne physician and two investors– Partnered with TargetPartnered with Target
Opened a kiosk in Towson, MarylandOpened a kiosk in Towson, Maryland
– 19 Minnesota locations19 Minnesota locations– Contracted directly with Best Buy and Contracted directly with Best Buy and
Guidant Corporation with on-site medical Guidant Corporation with on-site medical kiosk serviceskiosk services
– 84 locations in 10 states84 locations in 10 states– 300 clinics in 22 states by year end300 clinics in 22 states by year end
Origin Origin (cont.)(cont.)
CVS CorporationCVS Corporation– Acquiring MinuteClinic for $170 MillionAcquiring MinuteClinic for $170 Million– 6,100 retail and specialty pharmacy 6,100 retail and specialty pharmacy
storesstores– Currently 66 CVS stores with a Currently 66 CVS stores with a
MinuteClinicMinuteClinic– 450-500 locations or more by 2007450-500 locations or more by 2007
Retail LocationsRetail Locations
Partnerships are emerging Partnerships are emerging nationwidenationwide
Well-known retailers:Well-known retailers:-- Wal-Mart-- Wal-Mart -- Hy-Vee-- Hy-Vee
-- Target-- Target -- Albertsons-- Albertsons
-- Kroger-- Kroger -- Cub Foods-- Cub Foods
-- CVS-- CVS -- Osco Drug-- Osco Drug
-- Rite Aid-- Rite Aid -- Save-On Pharmacy-- Save-On Pharmacy
Convenience Clinic BrandsConvenience Clinic Brands
Express CareExpress Care MinuteClinicMinuteClinic MinuteCareMinuteCare FastCareFastCare Little ClinicsLittle Clinics Quick ClinicQuick Clinic
MedSpotMedSpot Ready ClinicReady Clinic Wellness Wellness
Express ClinicExpress Clinic Take CareTake Care Redi ClinicRedi Clinic
Attributes - Attributes - ClinicalClinical
Employ a Nurse PractitionerEmploy a Nurse Practitioner Treat non-emergent conditionsTreat non-emergent conditions Conduct physicalsConduct physicals Offer routine testsOffer routine tests Utilize algorithm based clinical Utilize algorithm based clinical
pathwayspathways Physician supervisedPhysician supervised Referrals offeredReferrals offered
Attributes - Attributes - OperationalOperational No appointment necessaryNo appointment necessary Open 7 days a week with extended Open 7 days a week with extended
evening hoursevening hours Sophisticated computer software utilizedSophisticated computer software utilized Easy consumer accessEasy consumer access Personal and attentive staff naturePersonal and attentive staff nature Available medical menus with posted Available medical menus with posted
pricingpricing Offer beepersOffer beepers Kiosks measure 10 ft. x 12 ft.Kiosks measure 10 ft. x 12 ft.
Attributes - Attributes - AdministrativeAdministrative Convenient locationsConvenient locations Low overheadLow overhead Limited square footage Limited square footage (110 - 440 sq. (110 - 440 sq.
ft.)ft.) Priced well below traditional Priced well below traditional
healthcare optionshealthcare options Covered by most insurance plansCovered by most insurance plans Promise patients an average waiting Promise patients an average waiting
time of 15 minutestime of 15 minutes
Clinical SafeguardsClinical Safeguards
Utilize Utilize Masters prepared Nurse Masters prepared Nurse PractitionersPractitioners
FollowFollow evidence based clinical evidence based clinical protocols with treatment algorithmsprotocols with treatment algorithms
SupervisedSupervised by a physician (M.D.) by a physician (M.D.) Medical DirectorMedical Director
AvailableAvailable physician consultation physician consultation Offer Offer referrals to primary and referrals to primary and
secondary care providerssecondary care providers
Clinical Safeguards Clinical Safeguards (cont.)(cont.)
Avoid Avoid treating children younger than 18 treating children younger than 18 months or people with chronic diseasesmonths or people with chronic diseases
MaintainMaintain complete patient records complete patient records FaxFax records to the patient’s primary care records to the patient’s primary care
provider to ensure treatment continuityprovider to ensure treatment continuity Patients returning with the same medical Patients returning with the same medical
complaint are flagged by the computer complaint are flagged by the computer systemsystem
Protocols prevent Nurse Practitioners from Protocols prevent Nurse Practitioners from prescribing antibiotics without a positive prescribing antibiotics without a positive test resulttest result
Urban vs. Rural SensitivitiesUrban vs. Rural Sensitivities
Urban communities are Urban communities are attractiveattractive marketsmarkets
Rural locations have Rural locations have appealappeal– Regional shopping venuesRegional shopping venues– Close proximity to larger Close proximity to larger
communitiescommunities– Physician under served areasPhysician under served areas– Little or no competitionLittle or no competition
Market Appeal Market Appeal and and
Consumer Consumer ReactionsReactions
The Three “P’s” of MarketingThe Three “P’s” of MarketingApplied to Convenience Care Applied to Convenience Care
ClinicsClinicsPProductroductPPrice rice PPositionosition
PProductroduct
Consumer acceptance/empowermentConsumer acceptance/empowerment– Options/choicesOptions/choices– ConvenienceConvenience– Appeal to working mothersAppeal to working mothers– Quality careQuality care– Timely: “You’re sick. We’re Quick.”Timely: “You’re sick. We’re Quick.”– AffordableAffordable
PPricerice¹¹
Typical primary care visit cost Typical primary care visit cost $109$109 Emergency Room visit costs Emergency Room visit costs $328$328 Urgent Care visit costs Urgent Care visit costs $125$125 Convenience Care fees:Convenience Care fees:
– FastCareFastCare $38$38– QuickClinicQuickClinic $39$39– MinuteClinicMinuteClinic $44$44– MedSpotMedSpot $40$40
¹ ¹ MN Council of Health PlansMN Council of Health Plans
PPositionosition Typical locations:Typical locations:
– Shopping CentersShopping Centers– Grocery StoresGrocery Stores– Retail CentersRetail Centers
Target MarketTarget Market– Cash customersCash customers
Only 5% of MinuteClinic patients are 60 years +Only 5% of MinuteClinic patients are 60 years +– Ages 18 months – 64 yearsAges 18 months – 64 years– Process insurance claimsProcess insurance claims
Some companies are reducing or waiving deductiblesSome companies are reducing or waiving deductibles– U.S. Bank in MinneapolisU.S. Bank in Minneapolis
– Individuals with HSA’sIndividuals with HSA’s ConsumerismConsumerism
– Career singles, students, and familiesCareer singles, students, and families
Wall Street Journal by HarrisWall Street Journal by HarrisInteractive SurveyInteractive Survey1
2,245 adults surveyed2,245 adults surveyed Convenience (92% satisfied)Convenience (92% satisfied) Quality of Care (89% satisfied)Quality of Care (89% satisfied) Staff Qualifications (88% satisfied)Staff Qualifications (88% satisfied) Cost (80% satisfied)Cost (80% satisfied)
1 October 2005
Consumer ReactionConsumer Reaction ““Patients think it’s a great alternative to an Patients think it’s a great alternative to an
emergency room.” emergency room.” Rhonda DukeRhonda Duke
““I thought they were very friendly and helpful. I thought they were very friendly and helpful. More convenient than having to wait elsewhere.”More convenient than having to wait elsewhere.”
Kristy ParrishKristy Parrish
““I think it’s a good idea. It’s convenient, and I think it’s a good idea. It’s convenient, and sometimes you just don’t need to see a sometimes you just don’t need to see a physician.” physician.” Walter FosserWalter Fosser
““What I like about this is, it’s hitting people where What I like about this is, it’s hitting people where they live, work, and shop. The advantage of it is they live, work, and shop. The advantage of it is that it’s the right kind of care at the right time.” that it’s the right kind of care at the right time.”
Mike WalkerMike Walker
Implications for Implications for Traditional Traditional MedicineMedicine
Potential Healthcare Industry Potential Healthcare Industry ConsequencesConsequences
Fragmentation - a possible/likely Fragmentation - a possible/likely outcomeoutcome
Lost market shareLost market share Patient panel erosionPatient panel erosion Financial lossFinancial loss
– Heavy private pay concentrationHeavy private pay concentration– Loss of overhead coverageLoss of overhead coverage
Primary care provider threatPrimary care provider threat
Market Potential for Market Potential for Retail Health ProvidersRetail Health Providers
“The MinuteClinic concept represents an almost indescribable potential for growth.” Michael Howe, CEO
MinuteClinic
Potential Potential Healthcare Healthcare
Industry Industry StrategiesStrategies
Questions to ConsiderQuestions to Consider
What is our business?What is our business? How can we best meet the needs of How can we best meet the needs of
patients?patients? Should we position ourselves to Should we position ourselves to
compete?compete? What should we consider doing?What should we consider doing? Are there any viable options?Are there any viable options?
Healthcare Industry OptionsHealthcare Industry Options
1.1. Co-ExistCo-Exist– Do nothing approachDo nothing approach– Accept consequencesAccept consequences
2.2. CollaborateCollaborate– Respond by working with othersRespond by working with others– Stratify existing fees based upon Stratify existing fees based upon
patient acuity levelspatient acuity levels– Become more customer friendlyBecome more customer friendly
Healthcare Industry OptionsHealthcare Industry Options(cont.)(cont.)
3.3. Partner/Acquire AssetsPartner/Acquire Assets– Establish an equity position with other Establish an equity position with other
providersproviders– Buy an established businessBuy an established business
4.4. CompeteCompete– Open a de novo businessOpen a de novo business– Establish kiosks in high density Establish kiosks in high density
consumer traffic areasconsumer traffic areas– Become more visible by creating a Become more visible by creating a
consumer driven model that is consumer driven model that is responsive to the changing market responsive to the changing market placeplace
ALMC Case ALMC Case ExampleExample
Guiding PrinciplesGuiding Principles Care provided in a retail settingCare provided in a retail setting Care provided for limited diagnosesCare provided for limited diagnoses Care provided by nurse practitionersCare provided by nurse practitioners Minimal offered ancillary supportMinimal offered ancillary support Care provided within a limited Care provided within a limited
timeframe timeframe Care is focused on immediate need Care is focused on immediate need
(rather than preventative health)(rather than preventative health) Posted charges and point-of-care Posted charges and point-of-care
paymentpayment Paperless environmentPaperless environment Serve as an innovative incubator Serve as an innovative incubator
Why Now?Why Now? Significant retail medicine growth in metro Significant retail medicine growth in metro
areas and spreading in out-state areas areas and spreading in out-state areas (Winona & Mankato)(Winona & Mankato)
Minnesota now allows N.P.s to practice Minnesota now allows N.P.s to practice independentlyindependently
Albert Lea retail corridor appears to be an Albert Lea retail corridor appears to be an ideal setting for a Convenience Care modelideal setting for a Convenience Care model
Anticipate Albert Lea Wal-Mart will follow Anticipate Albert Lea Wal-Mart will follow the direction of retailersthe direction of retailers
One-Third of local survey respondents One-Third of local survey respondents indicated they would use this new serviceindicated they would use this new service
Potential ALMC Potential ALMC Convenience Care Model Convenience Care Model
Patients referred to ALMC primary Patients referred to ALMC primary care for:care for:– Acute care diagnosisAcute care diagnosis– Follow up careFollow up care– Extensive lab, radiologyExtensive lab, radiology
120 – 140 sq. ft. kiosk located 120 – 140 sq. ft. kiosk located within an existing retail locationwithin an existing retail location
Potential DiagnosesPotential Diagnoses
LimitedLimited Posted along with chargesPosted along with charges
Potential Diagnoses Potential Diagnoses (cont.)(cont.)
Common Common IllnessesIllnesses– Pink eyePink eye– Ear infectionsEar infections– Sinus infectionsSinus infections– Strep ThroatStrep Throat– Allergies Allergies (over 6 years)(over 6 years)
– Bladder infections Bladder infections (females age 12-65(females age 12-65))
– Bronchitis Bronchitis (age 10-65)(age 10-65)
Additional Additional TreatmentsTreatments– Flu Flu (ages 10-65)(ages 10-65)
– LaryngitisLaryngitis– MonoMono– Pregnancy TestingPregnancy Testing– Swimmer’s EarSwimmer’s Ear– Minor lacerationsMinor lacerations
Potential Diagnoses Potential Diagnoses (cont.)(cont.)
Skin InfectionsSkin Infections– Athlete’s footAthlete’s foot– Cold SoresCold Sores– Deer Tick Bites Deer Tick Bites (over (over
age 12)age 12)
– Minor skin Minor skin infections, burns, infections, burns, rashes, poison ivy, rashes, poison ivy, ringworm, wart ringworm, wart removal, swimmer’s removal, swimmer’s itchitch
VaccinesVaccines– Diphtheria, Diphtheria,
Tetanus, PertussisTetanus, Pertussis– FluFlu– HepatitisHepatitis– PolioPolio– MMRMMR– MeningitisMeningitis– TdTd
GoalsGoals
Meet operating expensesMeet operating expenses GenerateGenerate
– Referrals to ALMCReferrals to ALMC– Positive patient satisfaction scoresPositive patient satisfaction scores– Positive patient outcomesPositive patient outcomes– Effective patient utilizationEffective patient utilization
Goals Goals (cont.)(cont.)
ALMC Innovation CenterALMC Innovation Center– Automated drug distribution Automated drug distribution
dispensing systemdispensing system– Physician referral resourcePhysician referral resource– Medical education and information Medical education and information
kioskkiosk
Exit StrategyExit Strategy
The expected goals will be reviewed The expected goals will be reviewed quarterly by the Clinical Practice quarterly by the Clinical Practice Committee for the first year and Committee for the first year and other appropriate review bodies other appropriate review bodies annuallyannually
If the goals are not met on a If the goals are not met on a consistent basis, an exit strategy will consistent basis, an exit strategy will be implementedbe implemented
One year space leaseOne year space lease
Questions?Questions?