At the Helm

Traditional primary care, meet next year's model

by Lisa Bielamowicz, MD

I recently took my kids to Walgreens, but it wasn’t to pick up a prescription or to stock up on candy. It was for primary care.

And if this experience represents the new standard for primary care delivery, traditional physician practices should be watching retailers like Walgreens very closely.

As I tweeted when we left the clinic:

How did our family end up at a drugstore for our primary care? To make a long story short, one of my kids woke up with a bad sore throat (pretty sure it was strep), the other one needed a flu shot, and our regular pediatrician doesn’t do weekend appointments.


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So, we drove to a relatively new Walgreens Take Care clinic in the leafy Van Ness neighborhood of Washington, D.C., a few miles away from my house. Walgreens was apparently making an investment in form and function with this facility. The first floor was a retail space, and an escalator led up to the second floor, which was devoted to “deep health”—pharmacy, medical supplies, and a clinic area with two exam rooms.

We rode up the escalator right at our scheduled time slot and were ushered into a well-equipped exam room by a smart, affable nurse practitioner who administered the flu vaccine, performed the strep test, and had us on our way within half an hour.

Though our reasons for seeking primary care were typical, our experience was anything but. Here are a few aspects of the visit I found remarkable, especially relative to conventional physician practices or even other retail clinics:

1. Centralized online scheduling. I was able to select a clinic location and a 15-minute appointment block for each child on the Walgreens online portal. The portal was simple and easy to use—and the Van Ness location had availability the same morning. I’ve been happy with my visits walk-in retail clinics in the past, but compared to the risk of waiting for hours at a walk-in clinic, I’ll take scheduled appointments any time.

2. Extended hours. This clinic allowed me to take care of my family’s primary care needs when they first arose, rather than waiting till Monday to see if my son had strep. In addition, to take my children to the doctor during working hours requires me to take time off of work, and often means they have to miss school as well.

3. Price transparency. As it happened, I didn’t even have to hand over a copay for our visit. But if I didn’t have insurance coverage, the clinic posts a clear and comprehensive list of cash prices for their services, on their website and in person. I can’t remember ever seeing a price list at a physician’s office—as a patient, when I was a practicing doctor, or in my current professional life.

4. Broad range of services. Though we were there for other reasons, I was particularly struck that one of the service categories for the Walgreens clinic is “monitoring and management” for “ongoing health conditions.” Seeing how easy it was to find and make an appointment, you could easily imagine some patients choosing to visit a clinic like this for care of their chronic conditions like diabetes or hypertension.

5. Professional clinic facility. To a patient with limited health care experience, this Walgreens clinic could be indistinguishable from many primary care offices: fully-outfitted exam room, professional staff, electronic medical records. And it had some consumer-friendly services that most doctors’ offices don’t, like touch-screen check in. This professional clinic facility—a model deployed not just by Walgreens but other retailers, including the Little Clinic—was a far cry from the “NP in a closet” experience of the previous generation of retail clinics.

A wake-up call for primary care practices

My visit to the Walgreens clinic left me wondering how long typical primary practices were going to be able to maintain their existing ways of operating, especially because it’s not just Walgreens moving into the health care delivery business.

The pharmacy chain CVS, which operates Minute Clinic services, has been signaling its commitment to a stronger health care identity by walking away from an estimated $2 billion in tobacco revenue and rebranding as CVS Health. The Little Clinic is expanding rapidly in grocery stores. And Walmart garned attention earlier this year by launching in-store comprehensive primary care clinics in Texas and South Carolina.

The reality is clinics like those that these retail giants have been launching deliver a better product than traditional primary care for many attributes that consumers value highly.

We recently ran a large-scale primary care consumer survey that found that when patients choose primary care providers, they are most concerned with access, convenience, and transparency—and not particularly attuned to brand or reputation. Or their relationship with their personal primary care physician.

Part of a larger shift in primary care strategy

If I were running primary care strategy for a health system today, though, I wouldn’t necessarily see this retail clinic disruption as solely a threat. For a variety of reasons—including the rise of population health management—we’re predicting that the generalist PCP model will become less prevalent, and the whole industry will move toward a more purpose-driven, customized model of primary care.

To be sure, primary care physicians and practices will still have a critical role. But in the health care marketplace that’s taking shape, we expect PCPs to be focused on the highest-value activities, such as managing complex chronic illnesses, directing care teams, and providing concierge-based care. Viewed in that context, retail clinic models like the Walgreens clinic are pieces of a larger puzzle, creating a more efficient and more effective primary care delivery system. Having said that, next time I need a strep test on a Saturday, I know where I’m heading.

12 primary care pointers from peer executives

Last summer, a working group of health system executives met at our offices to talk about the future of the medical home.

Explore 12 things we learned from that session on what defines an advanced medical home, adjusting your staffing model to support panel expansion, building and refining your data set, and more.


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