Two weeks ago, I had never heard of MinuteClinic. Today, I’m a fan. A division of CVS Caremark, Minneapolis-based MinuteClinic is a walk-in clinic in more than 500 CVS stores nationwide. A friend recommended it on a Friday when I was one week into a sore throat, and I couldn’t get in to see my primary care doctor for a strep test until Monday. So I went to CVS.
This CVS location was about the fourth closest store to my house, but still, it only took me 10 minutes to get there, and surprisingly, the clinic was empty. It took me a few minutes to enter my information on a kiosk, and moments later, the nurse practitioner called me into her office. She took care of everything—from taking my vitals to giving me a strep test and swiping my credit card (with the same insurance co-pay I would have paid at my doctor’s office). On my way out, she handed me a brochure that listed all the things the clinic can treat, from sinus to sprains, pink eye to poison ivy. Diabetics can go there to get their blood glucose screenings, and international travelers can get their vaccinations.
My only complaint: I wasn’t clear that she would only call the next day if the test were positive. So I waited all day for a call that never came, wondering if I’d need a prescription. I finally tracked down a toll-free number, where they gave me my results (there’s no way to call an individual clinic). Two days after my visit, I got a nice call from another nurse practitioner checking to see how I was feeling. She reminded me the importance of replacing your toothbrush when you’re sick. How convenient, I thought; I can get this at CVS. “Feel better,” she said, and then we hung up.
Last week I talked with MinuteClinic President Andrew Sussman, the former executive vice president and chief operating officer of UMass Memorial Medical Center. Excerpts of our conversation are below.
We have 560 sites in 26 states, almost all in CVS stores. We have seven or eight in corporate locations. We’re adding 100 sites a year over the next five years, to give us about 1,000 locations. We’ve seen 9 million patients since inception in 2000 (when it was called QuickMedx, before CVS purchased it in 2006). Eight million of those visits were since 2007.
Last year our growth in patient visits was 22 percent, at a time when physician visits are actually declining. In 2009, it increased by 49 percent. And that’s because we are offering high quality, affordable, accessible health care
All of our nurse practitioners use clinical guidelines from the medical societies to drive the care that they provide. MinuteClinic is the first retail health care provider to receive accreditation by the Joint Commission.
From a quality standpoint: A study by the Rand Corporation [in 2009, published in the Annals of Internal Medicine] showed that MinuteClinic quality was excellent, and cost was 40 to 80 percent less than other sites like physicians offices, emergency rooms and urgent care sites.
We see patients who have one of four different types of conditions:
- Acute—sore throat, ear infection, sinus infection;
- Vaccinations, including flu shots;
- Chronic condition management—diabetes, hypertension, high cholesterol; we monitor in these areas;
- Physical exams for camp or school.
Eighty percent of people use their health insurance. They usually pay their co-pay, so from that standpoint, it’s a familiar expense. Among the patients we see, about half of them don’t have a [primary care] physician.
Finally, access: We’re open seven days a week, and our hours stretch into the evening. They can walk in at any time and be seen.
What does it cost to set up a MinuteClinic?
We don’t give out this information, because we’re a publicly traded company. But the costs we’re able to keep down, which allows us to keep the costs down for our patients.
We’re kind of a blend of both. We are not and don’t intend to be a primary care home; on the other hand, urgent care and emergency rooms have a broader scope. We coordinate with primary care doctors. Whenever a patient is seen, we update their primary care doctor. We send faxes to thousands of physicians every day to update them on the patients.
Do you have statistics on the most common reasons people come in, and the breakdown of adults versus kids?
I would say the most common things are the most common conditions—sore throat, sinus infection. We do a lot of flu shots. We don't give the breakdown on the patients, but we do see more adults.
Why does this model work?
We’re at a unique moment in our national discourse in health care. We’re trying to provide a service at a level of access that isn’t available elsewhere. We stick to clinical guidelines, so the care they would get in California is the same as they get in Connecticut.
In addition, our prescribing costs are lower. Patients find our locations convenient. We don’t see ourselves as a substitute for primary care physicians. We see ourselves a part of a team of providers.
Tell me about some of the technology MinuteClinic is using to keep costs down. For example, when I checked in, there was just a kiosk, instead of a human receptionist.
We’re looking for ways to provide great care for patients that is financially reasonable; one of the ways to do that is to use technology. So patients check in with a kiosk, and then we have one provider instead of having a lot of support staff, which wouldn't allow us to be as economical.
We use an electronic medical record, which helps us in terms of not having charts to file. We do a lot of electronic communication. We do point-of-care testing in our clinics, and the results appear immediately.
How much do we need to keep an eye on some of this new technology to make sure it’s accurate and performing correctly? The nurse practitioner took my blood pressure with a digital device, and the numbers were way off. So she redid it with the manual one, and the numbers went down.
Anytime technology is used, you need to be on guard for tests that don’t make sense—and I’m glad our nurse practitioner was on guard. In order to get Joint accredited, we have intensive surveys that test and challenge all our technology and our people. We’re always on guard to make sure things are working properly.
When I left, the nurse practitioner handed me some printed pages with my personal information and a summary from the visit, and she said, “We don’t keep any records here.” But obviously, you do keep them; they’re just on the computer. Tell me how you’re protecting the patient's privacy.
We have electronic records that are intensely protected, just the same way as CVS Pharmacy. We offer to fax those to the patient’s physician, but only with the patient’s approval, and in the future we will send them electronically.
What is your relationship with CVS Pharmacy?
Our prescribing is less than other sites of care--that’s what the Rand study showed. When we do prescribe, they can get it filled at CVS, but if they prefer to take it elsewhere, we can e-prescribe it somewhere else. From that standpoint, it’s convenient to have a pharmacy here, but they don’t have to use that pharmacy.
Do the nurse practitioners receive special MinuteClinic training?
We have an extensive orientation. We have about 1,500 providers now—nurse practitioners and a few physicians assistants. We have to make sure they follow our clinical guidelines. We also have ongoing efforts to do continuing education. And each nurse practitioner or physicians assistant has a collaborating physician who is available anytime that provider is practicing to answer questions by phone and to do chart reviews. Everyone in our company is board certified, almost always in family medicine.
What do primary care doctors think of MinuteClinic?
Many of them have accepted what we’re doing, and we even get referrals. There’s a growing recognition that there’s shortage of primary care, and that we can be part of the team. We see them as complimentary.
Even patients that have a physician, there’s a difficulty about going to be seen and taking a half day off work for a sore throat. What happens is people end going without care sometimes. One of the principals of MinuteClinic is you can go in and be seen.
There’s demand today, and that’s before health reform really takes effect. The Affordable Care Act is terrific in terms of providing insurance for patients, but the problem is that there’s a real profound shortage of primary care in the U.S.