Convenient care sites — walk-in or quick appointment locations for low-acuity care — including urgent care and retail clinics inside stores such as Walgreens, CVS or Walmart, have been expanding for a decade, most notably within the past two years.
Meanwhile, primary care providers are experiencing new pressures to help patients receive proper care in the right setting.
Due in part to a shortage of primary care physicians and increased difficulties accessing care during the pandemic, convenient care locations emerged as primary care's main disruptors, making inroads into a $300 billion industry.1 These sites are changing how primary care gets delivered in many communities and how patients view it.
Primary care providers will continue to play a vital role in the future of healthcare. Learning to market that value and work with patients on the appropriate use of convenient care, implementing new convenient care services and improving care coordination are the keys to competing alongside these disruptors.
The growth of convenient care clinics
Urgent care centers and retail clinics have multiplied in the past decade and often provide first access for many patients. These centers were initially created to relieve emergency room burdens by providing immediate care for cuts, broken bones or certain illnesses.
But the landscape is changing, as seen in these Health Industry Distributors Association (HIDA) reports' urgent care statistics for 2021:
- The urgent care market expects to grow 5.9% annually over the next five years2
- 20% of urgent care clinics plan to expand into primary care2
- In 2020, retail clinics, including CVS Health, Walmart and Walgreens, invested in population health management to help people manage chronic diseases3
- The COVID-19 pandemic led people to seek care at retail clinics, and 55% of patients plan to visit a retail health clinic even after the pandemic2
These changes are partly driven by the patient's desire for quick access to care and a shortage of primary care physicians.
Lorilea Johnson, FNP-BC, DNP, a family nurse practitioner for more than 20 years, currently provides primary care to patients at a Veterans Affairs clinic in southeastern Missouri.
"People come to convenient care one because it's convenient and two because they can't get into primary care," she says.
Many patients can't get to a doctor's office during regular hours. In addition, during the pandemic, Johnson saw a rush of patients at the walk-in clinic where she worked because private practices weren't attending to those patients.
Key challenges for the primary care sector
While more patients are visiting convenient care facilities, there's an opportunity to further educate patients on the best role that convenient care can play.
A few key challenges within the industry include:
1. Fewer people visiting primary care providers. Recent surveys have found generational shifts in relationships with primary care:
- Only 58.2% of adults expect to have at least one in-person visit with a primary care provider in 20221
- About 45% of people ages 18 to 29 do not have a primary care provider4
- 93% of millennials want a provider relationship that cares for them more than just when they're sick4
2. Patient confusion. Another challenge for the primary care sector is that, with so many choices, patients don't know where to go.
"I've had patients who come to a walk-in clinic with the expectation they will get the same workup they would get from a primary care provider or specialist," Johnson says.
"They don't realize that certain imaging tests require preauthorization, that there's a process we have to follow."
3. Fragmented care. Going from clinic to clinic leaves patients with a difficult trail to follow because most actions taken are not in the patient's medical record and must get pieced together from the patient's memory.
Mike Sevilla, M.D., is a physician and owner of the Family Practice Center of Salem in Salem, OH. He's also seen these effects on patient care during his 21 years of family medicine.
"Even in our small town, we're seeing an impact on how medicine is delivered with the rise of urgent care centers," he says. "Patients may receive treatment there, but when they have a side effect, they call us."
"With the fragmentation of care, we don't get documentation from urgent care centers," he says. "One challenge we're dealing with is having to put the pieces together."
When it comes to chronic care management, primary care providers are the ones that know their patients the best.
"Urgent care has a more transactional role," Dr. Sevilla says. "In our office, we emphasize the advantage of having a longitudinal relationship with patients."
Ways primary care competes with convenience care
Despite the challenges, there are numerous ways primary care can compete with convenient care clinics:
1. Be more convenient. Simply put, primary care providers need to match convenient care sites for a better patient experience.5
"Offices like us have to be responsive to patient needs," says Dr. Sevilla. "We need to be flexible, like doing extended hours for our patients.
"We know they're getting testing at urgent care offices for strep throat, bladder infections and COVID-19. We're sensitive to what services urgent care is delivering, and we want to deliver some of those services ourselves."
2. Educate your patients. Patients don't know when best to visit an urgent care clinic or when a retail clinic is more appropriate. "People don't intentionally choose the wrong place; they just don't know where to go," Johnson explains.
Education options include:
- Taking the time to explain the role of different centers
- Discussing the best to call the office for an appointment
- Teaching how to keep of track urgent care visits and posting printed information that explains the role of each center
Meanwhile, Dr. Sevilla recalls a patient who visited urgent care for chronic pain. He took time during the subsequent visit to explain that a primary care physician is the best choice for ongoing issues.
3. Educate your staff. When primary care offices get busy, the front desk staff sometimes refers patients to convenient care centers. This can sometimes result in confusion.
"During the pandemic, we were swamped, but we had walk-in patients referred from their primary care office who were also swamped," Johnson said of her time working in a walk-in clinic. Some of these patients' primary care doctors could have served them better.
In her experience, even the front desk staff didn't understand the role of convenient care clinics at times. Staff education and risk-stratifying tools, such as the Marburg Heart Score and HEART Pathway score — that help office staff and nurses know when to refer patients — can also prove beneficial.
4. Invest in marketing and community outreach. Urgent care centers and retail clinics tend to have big marketing budgets, making competing with them difficult.
For his practice, Dr. Sevilla believes word of mouth is still the best type of marketing because making an effort to reach new or further engage with existing patients can help draw people into primary care.
"We need to communicate our value to the community and patients," he says. "But most practices have little or no budget for marketing."
Dr. Sevilla also encourages doctors to get on social media, either personally or through a designated superuser in their office. He suggests posting about medical topics, such as immunizations and heart disease, to promote the value of family doctors and primary care.
Johnson also emphasizes the importance of marketing and suggests offering screenings to encourage otherwise healthy people to begin establishing a relationship.
5. Improve your care coordination. With multiple visits to convenient care centers for minor or ongoing complaints, it's hard for primary care providers to maintain a clear picture of their patients' health.
"Patients need a hub," Johnson says. "They need someone who knows them, can look at their chart and coordinate their care, and knows when they need specialists."
Dr. Sevilla thinks it's beneficial to have improved communication with these convenient care centers. Technology may play a role in the future to better coordinate care, but the tools aren't available — or adopted — yet.
Primary care is an invaluable service, lowering healthcare spending and improving outcomes.5
But it's been undervalued within the industry for a long time. Primary care makes up just 5 to 7% of healthcare spending, compared with 38% for hospitals and 14% for prescription drugs.6 Yet, patients rely on this care, even if they don't fully understand why. Finding ways to reach patients, engage the community and coordinate with local convenient care centers ensures patients receive the care they need in the right setting, at the right time.
© 2022 McKesson Medical-Surgical Inc.