Becker's Hospital Review

19 Clinical Integration & ACOs Though the strategies behind the creation of retail health and urgent care clinics are the same — to provide more patient-centered care and care in lower cost sites — the two do play different roles. "Retail outlets are really intended and designed to be an extension of a phy- sician office, dealing with things like colds and coughs," says Casey Nolan, managing director in Navigant's healthcare practice. "Urgent care will see those things, plus more," and will typically have lab capabilities, he explains, pulling in patients who would otherwise go to the emergency room. So, while urgent care and retail health are similar, hospitals and health sys- tems tend to focus on one strategy for each at a time. Here is how two health systems decided which to pursue. Retail health University of Missouri Health Care in Columbia, which already has two ur- gent care clinics in operation, chose to focus on developing and expanding retail health clinics. "Retail clinics are a really low-cost option," says Mitch Wasden, EdD, CEO and COO of MU Health, even compared to urgent care centers, which are less expensive than ERs. ERs and urgent care clinics are more expensive than retail convenience clinics because of higher ancillaries like labs and X-rays. Because of the rise of high-deductible health plans, Dr. Wasden says patients prefer retail health clinics. "Patients are less willing to pay for an…urgent care clinic visit for a UTI or an earache if they can go to a lower cost convenience care clinic," he says. With that in mind, he has spearheaded a partnership between his health system and a local grocery store chain to build retail clinics in store loca- tions. "We'll benefit from the foot traffic that's in the stores," he says, and the stores already have convenient parking lots and retail internal and external signage. And Dr. Wasden is not alone in expanding MU Health's retail clinics: a 2013 Accenture report found the number of retail health clinics in the U.S. is pro- jected to double by 2015. The retail clinics will have MU Health's name and will be staffed by its nurse practitioners. The system will pay rent to the grocery store and do billing and collections on its own. Dr. Wasden expects the centers will need to see about 17 patients per day to break even, but the system is projecting about 20 daily visits. Urgent care Other systems and hospitals have chosen to focus more on developing their urgent care base, both to expand their care continuum and get patients out of the ER and into a lower cost of care site with the move toward population health. LifeBridge Health, an integrated healthcare delivery system based in Balti- more, has been developing a large primary care and specialty physician base, as well as post-acute care services including nursing home, rehabilitation and home health, but was lacking in urgent care, according to Stephen Witman, vice president of business development/financial and capital planning at LifeBridge Health. "We started thinking about expanding our footprint and finding opportunities to provide lower cost of care alternatives to the emergency department set- ting," he explains. To expand its care continuum, LifeBridge partnered with ExpressCare Urgent Care Centers, an urgent care provider with 10 sites in the Baltimore area, in October 2013. More sites are currently being developed. The two organizations are cobranding the existing urgent care centers and are working on linking up their two separate electronic health re- cords to better coordinate care for patients. The partnership "extends our branding out in the community and gives us a much more visible face," Mr. Witman explains. Conclusion Some systems may choose to pursue retail health in order to expand their of- fice-based care and offer a very low-cost option with patient-centered hours. Others build up urgent care to help keep patients out of the ER and expand their pre-acute care continuum. But no matter which approach hospitals and health systems decide to pursue, it is "absolutely imperative" for organiza- tions to consider one or both as part of their overall population health strat- egy, according to Mr. Nolan. "We're going to continue to see this huge growth in retail and urgent care," he says. "We can fully expect that to be the case in the foreseeable future." Dr. Knight agrees. "The whole name of the game in the [population health management] scenario is providing the appropriate care in the most cost- effective manner and location," he says. "I think it's absolutely something that they ought to consider." n Retail vs. Urgent Care By Heather Punke "patients are less willing to pay for an urgent care clinic visit for a uti or an earache if they can go to a lower-cost convenience care clinic." — Mitch Wasden, EdD, CEO and COO of University of Missouri Health Care

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