Getting Your Health Care at Wal-Mart

http://online.wsj.com/article/SB112847351020560194.html?mod=djemHL

Getting Your Health Care at Wal-Mart
To Boost Sales, Retail Chains
Open In-Store Clinics;
A Strep Test and a Bar of Soap

By JANE SPENCER
Staff Reporter of THE WALL STREET JOURNAL
October 5, 2005; Page D1
Americans can increasingly get basic medical care in the same place they
buy toothpaste and light bulbs.
In a development that has broad implications for the nation's
primary-care system, a rising number of major pharmacy and retail chains
-- including CVS Corp., Wal-Mart Stores Inc. and Target Corp. -- are
opening in-store health clinics. They offer patients fast access to
routine medical services such as strep-throat tests, sports physicals
and flu shots. The clinics, which typically charge between $25 and $60
per visit, don't require an appointment and are open during pharmacy
hours including evenings and weekends. To keep costs down, they are
staffed by nurse practitioners, who can legally treat patients and write
prescriptions in most states.
The trend is rapidly spreading in pharmacy chains as they look for ways
to stem losses to mail-order pharmacies and big-box stores. Three of the
nation's largest drugstore chains -- Rite Aid Corp., Brooks Eckerd
Pharmacy and Osco Drug -- have announced plans to open health clinics in
the coming months. All three have partnered with a Pennsylvania-based
health-care start-up called Take Care Health Systems LLC that will lease
space inside the pharmacies and operate the clinics.
Take Care is also in talks with Walgreen Co., the nation's largest
pharmacy chain (by sales volume). The first Take Care clinics will open
at Rite Aid stores in Portland, Ore., later this month; Take Care aims
to have 1,300 clinics open by the end of 2007.
Other major chains have been testing the in-store clinics. CVS and
Target are working with Minneapolis-based MinuteClinic to open clinics
at stores in markets including Minneapolis, Baltimore and Nashville.
Wal-Mart is working with InterFit Health and other companies to open
clinics in Oklahoma, Arkansas, Florida and other states. (The pharmacy
chains must partner with outside companies because federal health-care
laws banning "self referrals" prohibit pharmacy chains from running
their own clinics.)

The new clinics are aimed at everyone from harried parents dropping by
with sick kids on the weekend, to busy professionals ducking in for a
prescription during work hours. While the retailers don't profit
directly from the new services, the hope is that the clinics will boost
business if patients fill their prescription at the store pharmacy, or
pick up other items on their way out. (Target's MinuteClinics even offer
patients a clip-on beeper after they sign in, to encourage patients to
shop until the nurse practitioner is ready to see them.)
The trend is drawing criticism from some doctors groups, who could lose
business if patients turn to the clinics for basic care. Doctors also
contend that patients could wind up with lower-quality care because the
clinics don't have physicians on-site.
"Serious illnesses sometimes present with simple symptoms," says Edward
Hill, president of the American Medical Association. "A cough might be
something as simple as a cold, or something as serious as congestive
heart failure. The ability to ferret out the 20% of serious illnesses
that present with simple symptoms is what we went to medical school for."
But some patients are more concerned about convenience. When Terri
Whitesel, 56 years old, who runs a marketing consultancy in Minneapolis,
had an allergic reaction to a bug bite last month, she dashed into a
MinuteClinic at a Target in between meetings at work. "I didn't want to
go to the doctor and sit around waiting with a bunch of people who are
really sick," says Ms. Whitesel.
The nurse practitioner was busy with another patient, but Ms. Whitesel
wrote down her name, got a beeper at the check-in counter, and shopped
for birthday cards until the nurse beeped her five minutes later. The
entire visit took less than 15 minutes and she wound up with a
prescription for an anti-inflammatory drug.
Both MinuteClinic and Take Care work with a network of local physicians
who are available by phone if the nurse practitioner needs help with a
diagnosis. And the companies say the clinics can act as an entryway to
the primary-care system because they offer referrals to patients who
don't have a doctor.
The companies limit their services to a strict list of roughly 30 basic
services and diagnoses, ranging from athlete's foot to tetanus shots.
Neither company allows nurse practitioners to prescribe drugs for health
situations that require continuing care such as antidepressants, birth
control or heart medications.
Health insurers have embraced the concept because the clinics promise
considerable savings. While a typical doctor visit for a basic illness
costs an insurer about $110, a visit to one of the clinics usually costs
under $60. In addition, the clinic services are far cheaper than the
emergency room, which is where patients often wind up when they need
medical care outside business hours. (A strep throat test at the
emergency room can cost over $300.)
Some insurers are actively encouraging patients to use the clinics by
lowering the co-pay. In Minnesota, companies including Blue Cross Blue
Shield of Minnesota and Graco Inc., have reduced or eliminated co-pays
for employees who opt to use a MinuteClinic instead of a doctor. Take
Care has deals in place with several insurers in Portland.
Chain drugstores have been grappling with relatively flat sales for the
past few years. While pharmacies have broadened their offerings over the
past couple of decades, and now offer everything from photo developing
to outdoor grills, prescription-drug sales still account for about 68%
of their business. To hold onto that business, pharmacies are
increasingly trying to establish themselves as wellness centers that
offer a constellation of health-care services related to prescriptions.
The management teams behind both of the leading companies in the field
-- Take Care and MinuteClinic -- have experience in other
consumer-focused industries. MinuteClinic's new chief executive officer,
Michael C. Howe, is the former president and CEO of the Arby's fast-food
chain, and previously worked for KFC. Hal Rosenbluth, chairman of the
board of Take Care, is the former CEO of Rosenbluth International, a
travel company acquired by American Express Co. in 2003 in a deal valued
at over $300 million.
Take Care's business model has been influenced by Mr. Rosenbluth's
background in the travel industry, and the clinic model relies heavily
on technology to increase the efficiency of care. When patients arrive,
they check themselves in at a touch-screen computer terminal -- much
like an airline self-check-in kiosk -- where they can swipe a credit
card and enter basic information about their symptoms and family history.
In one of the more-novel uses of technology employed by Take Care, a
computer software program will be involved in actually diagnosing
illnesses. The patient's sign-in information will be transmitted
electronically to a computer terminal inside the treatment room, where
the nurse can enter additional information about the patient's symptoms
and conditions as he or she talks with the patient.
The software system will eventually generate a diagnosis and a
recommended course of treatment. If the nurse practitioner disagrees
with a computer-generated diagnosis, he or she can opt to override the
system. When a prescription is written, it will be transmitted
electronically to the store pharmacy, or another pharmacy. The system
will also create an electronic medical record for each patient that can
be transferred to a primary-care physician.

Write to Jane Spencer at jane.spencer@xxxxxxx

--
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This article is posted under fair use rules in accordance with
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and informative purposes. This material is distributed without profit.
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