CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

Walk-in Clinic Market and its Impact on the Healthcare Delivery System

A graduate project submitted in partial fulfillment of the requirements

By
Wendy Ruiz

August 2019
The graduate project of Wendy Ruiz is approved:

________________________________________ ______________________
Dr. Frankline Augustin Date

________________________________________ ______________________
Dr. David Powell Date

________________________________________ ______________________
Dr. Kyusuk “Stephan” Chung, Chair Date

California State University, Northridge

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 TABLE OF CONTENTS
Signature Page ……………………………………………………………………….. ii
Abstract ………………………………………………………………………………… v
Introduction ……………………………………………………………………………. 1
Scope of the Problem ……..…………………………………………………………… 3
Statement of Purpose ……..……………………………………………………… 4
Literature Review ………………………………………………………………………. 5
Retail Health Clinics …………………………………………………………… 5
Cost of Retail Clinics …………………………………………………… 7
Location of Retail Clinics ………………………………………………. 7
Urgent Care ……………………………………………………………………. 8
Cost of Urgent Care Services ……………………………………........... 9
Walk-In Clinic Comparison ……………………………………………………. 10
Hospital System Partnership with Walk-In Clinics …………………………….. 12
Affordable Care Act ……….…………………………………………………… 13
Healthcare Delivery Systems and Frameworks ………………………………… 15
The Triple Aim ……………………………………………………….... 15
Traditional Healthcare Model …………………………………………. 16
Value-Based Care …………………………………………………….... 16
Consumer Driven Model ………………………………………………. 16
Regulatory Measures and Licensing of Walk-In Clinics ………………………. 17
Policy Limitations ……………………………………………………………... 17
Methodology …………………………………………………………………………… 20
Findings / Analysis …………………………………………………………………….. 21
Meeting the Demands of Consumer Driven Healthcare Delivery ………………. 21
Patient Preferences for Clinic Usage ……………………………………………21
Challenges and Barriers ……………………………………………………...... 22
Recommendations ……………………………………………………………… 23

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Conclusion ……………………………………………………………………………… 25
References ……………………………………………………………………………….26

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 Abstract

Walk-in Clinic Market and its Impact on the Healthcare Delivery System

By
Wendy Ruiz
Master of Public Administration, Health Administration

Retail health clinics and urgent care clinics – generally known as walk-in clinics – have

represented a large and rapidly growing sector in the landscape of the delivery of health care. These

clinics aim to relieve the excess amount of utilization of emergency rooms and give better access

to primary care services. The walk-in clinic market has been shown to promote the delivery of care

to patients who want to receive care when it is convenient to them, as well as lower the costs of

care. This research project aimed to systematically review the literature to analyze the surge in

both retail health clinics and urgent care clinics, their scope of practice, and their impact on the

healthcare delivery system. The findings show that walk-in clinics are capable of providing the

essential primary care needs in a retail clinics and more serious services in an urgent care clinic.

Hospital system partnerships have become a trend that has allowed for the delivery of care to fill

in the gaps and provide better coordinated care. The continued use of walk-in clinics has created

an influence for more clinics to become regulated and certified so their scope of practice will

continue to grow. Therefore, policy makers and stakeholders should provide more support in the

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areas of licensing and regulatory measures. With the proper licensing and regulations, these clinics

can broaden the scope of practice to nurse practitioners and physician assistants.

Keywords: Retail clinics, urgent care clinics, walk-in clinic market, walk-in clinic market

and the delivery of the healthcare system, policy implications of walk-in clinics, healthcare

models.

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 Introduction

Background

The walk-in clinic market gives an opportunity to provide a healthcare delivery system that

does not require a patient to meet unaccommodating scheduling to seek care. Conventionally, if

the patient wants to seek care through its health care system, they can expect to receive care from

a primary care physician sooner rather than later or for more serious issues, they would visit an

emergency department. Emergency departments are intended for more serious and life-threatening

cases and not for services that should be done with a primary care physician. However, when

scheduling a visit to see a physician is not in the interest of the patient, they seek care in emergency

departments where the costs are seemingly higher.

The walk-in clinic market has put an impression on the future of delivering care. With the

passage of the Affordable Care Act (ACA), healthcare delivery systems and hospital systems

would change its methods to reach the three overriding goals of change: access, quality, and cost.

Retail clinics and urgent care clinics provide opportunities for the delivery of care in an affordable

and convenient way. Although retail clinics are not part of the traditional healthcare system model,

their growth in numbers has given consumers an opportunity to seek care in a convenient and cost-

effective way. Retail clinics bring forward a convenience culture that meets the needs of the

consumer driven healthcare environment. In this environment, patients can seek care in a timely

manner and expect the cost of care to be transparent. Patients who choose to seek care at walk-in

clinics do so because of the convenience to access to primary care services, transparent costs and

location.

Policymakers need to push for more regulation and accreditation of walk-in clinics to

justify their services and give importance to how clinics perform and if they are giving the public

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healthcare that is accessible, affordable, efficient, good quality and effective. So, we can ask, what

more can the walk-in clinic market do to provide better care coordination and further increase

their usage under the changes to healthcare delivery system and meeting the consumer demand?

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 Scope of the Problem

Walk-in clinics, also referred to as retail clinics or urgent care clinics, have significantly

expanded across the healthcare market. Both retail health care and urgent health care promote

access to care by allowing a patient to receive care when they need it—for example, after doctor

office hours or to prevent a high cost medical bill from an emergency room visit. Many patients

visit retail clinics or urgent care due to the gaps we have seen in the healthcare delivery system.

An increased number of patients do not have a primary care physician or want to prevent receiving

high medical bills from an emergency room visit.

Since healthcare reform, we have seen a shortage of physicians in the healthcare industry.

The shortage of primary care physicians is another factor that has contributed to the rise in retail

clinic increase and usage. Another factor contributing to the rise in retail clinics and urgent care

usage is patients needing care available 24/7. Retail clinics offer care in alternative to waiting for

an appointment with a physician or long wait times in an emergency room. According to a survey

done by Merritt Hawkins, the average wait time for patients to be seen by a family medicine

practitioner was 29.3 days (Rege, 2017).

Healthcare reform has contributed to the rise of walk-in clinics to cater to the consumer

driven model of delivering care. The Affordable Care Act (ACA) aimed to create innovative ideas

for medical care delivery methods and to lower the cost of care. Since the passage of the ACA, we

have seen the greater utilization of walk-in clinics, which offer the same services as a visit to a

primary care physician. Since recognition of walk-in clinic usage is used among more patient each

year, policy makers are now beginning to have an idea of how well they are doing or if they are

contributing to more coordinated care. Many retail clinics are introduced as an alternative to

physician office visits because of their convenience, low costs and accessibility.

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Statement of Purpose

The purpose of this research project is to examine the expansion of walk-in clinics

influenced by health care reform and limitations that the expansion of clinics will face. This

research project will identify aspects of the retail clinic and urgent care market and its delivery of

care that highlight the consumer-focused demand. To further analyze how both retail clinics and

urgent care centers have influenced the U.S healthcare system, we will look at how they deliver

care to meet the same demands of healthcare business models.

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 Literature Review

The walk-in clinic market emergence into the healthcare delivery system has caused a

disruption in the way the traditional healthcare model has provided care to the patients’ health care

needs. Patients no longer need to accept long wait times at an emergency room visit or wait for

the next available appointment to see their primary care physician. The trend in the walk-in clinic

market – also known as retail clinics and urgent care clinic have provided care that meets the

demands of producing better coordinated care.

Retail Health Clinics

The first retail clinic was established in 2,000 with 1,200 clinics across the nation (Robert

Wood Johnson Foundation, 2013). As shown in Figure 1 (Accenture, 2015), there were 351 retail

clinics in 2006. Over the next eight years, there was a 445 percent increase in the number of retail

clinics and three years later in 2017, there was a 45 percent increase. The emergence of retail

clinics was based on the walk-in concept. Retail clinics are intended to be convenient for patients.

Patients can locate retail clinics in big-box stores offering healthcare to consumers in a convenient

manner. Three-quarters of retail clinics are owned by CVS and Walgreens, and the rest of the retail

clinic environment is separated among Walmart, Target, Kroger and Rite Aid (Bresnick, 2017).

Retail health clinics were established to deliver care at a low cost and as an alternative to

emergency rooms and physician office visits for patients to seek care. Since retail clinics began to

receive recognition for their services, they have continued to grow, leading to a shift away from

needing to see a physician or from visiting emergency rooms.

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Figure 1 (Accenture, 2015):

Healthcare systems continue to grow to find new ways to provide care to patients in the most

convenient and affordable way possible. Consumers of care want the fastest way to get care

without the need to take time off work to meet the hours of the physician’s office hours or high-

priced emergency visits. Retail clinics are clinical office settings outside of a hospital or physician

office and are located in retail stores.

Retail clinics are staffed with nurse practitioners and physician assistants who are certified in

providing care to episodic minor illnesses, physicals and flu vaccinations. The most common

illnesses that are treated in a retail clinic include sore throat, common colds, flu symptoms, cough,

sinus infection, immunizations

Retail clinics offer weekend hours and stay open later during the week. Consumers who prefer

quick services and a fixed and transparent cost for services can find that in a retail clinic. This

dynamic of services offered in the healthcare industry depend on the walk-in approach for

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healthcare consumers and has greatly influenced the healthcare consumerism trend in receiving

the most convenient care. Consumers of care want the fastest way to get care without the need to

take time off work to meet the hours of the physician’s office hours or high-priced medical bills.

The expansion of retail health clinics in the healthcare market was aimed at addressing the

need for patients to seek primary care in a more convenient and affordable care from clinics that

offer services with upfront and low costs.

Cost of Retail Clinics

The price of retail clinics will depend on which service of care will be provided. The costs

of services will be readily available to patients and some prices are posted on an electronic sign.

The cost for visiting and receiving care at a retail clinic can be between $45 and $75. Health

insurance is also accepted in clinics – some health insurance companies will cover and reimburse

clinics, while others waive the co-pay fees (National Conference of State Legislatures, 2017).

Location of Retail Clinics

As shown in the image below, the number of clinics per state can be found across the

United States in southern and midwestern states (Rudavsky, Pollack, & Mehrotra, 2009). The map

shows the location of 982 retail clinics that operate across the United States. About 78% of retail

clinics are located inside drug stores and 93.3% are located in grocery stores and retail warehouses

(Rudavsky et al., 2009). The large circles that are shown in figure 2 demonstrate the cities with an

average of 46-65 retail clinics – Atlanta, Chicago, Miami, Minneapolis -St. Paul, Los Angeles and

Washington, DC.

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Figure 2 (Rudavsky, Pollack, & Mehrotra, 2009):

Retail clinics tend to be in high-income and urban and suburban areas – putting more

concentration of providing care to white residents and fewer black and Hispanic patients (Lagasse,

2016).

Urgent Care

Urgent care centers are freestanding clinics that are commonly known as after-hour walk-

in clinics, minor emergency centers or minor care clinics. An urgent care clinic provides care that

is between a primary care physician’s office visit and an emergency department visit. The care that

can be seen in urgent care centers is more aggressive than family practice. Like retail clinics, urgent

care centers offer the same convenience to care with walk-in clinic hours that are 24 hours, 7 days

a week, and offer a more complex array of services which include:

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 - Treatment of accidents and falls

- X-rays and laboratory tests

- Sprains and strains

- Infections

- Fractures.

There is a wide range of urgent care clinics that function like emergency departments. The

American College of Emergency Physicians (2016) believes that urgent care clinics hold a place

to meet the needs of unscheduled care. They are staffed with a board-certified emergency physician

and also have onsite laboratory services – including advanced diagnostic equipment, such as CT

scan and X-ray (Urgent Care Centers, 2017).

Cost of Urgent Care Services

The cost of an urgent care visit depends on the services of the urgent care clinic. Alternative

to visiting and emergency room and expecting to pay a large medical bill, urgent care clinics can

manage and treat the same services. An estimate of 25 percent or 50 percent of diagnoses can be

treated at urgent care clinics (Weinick, Burns & Mehrotra, 2010). The patient will expect to be

treated and receive care at a lower cost. The cost of an urgent care visit on average will be $149

with a copayment of $33 (Heath, 2018).

The decision for a patient to choose between an emergency department and an urgent care

clinic will depend on the severity of the condition and the cost and convenience. Figure 3

(America’s Debt Help Organization, 2019) shows the considerable difference in cost between

emergency rooms and urgent care. Urgent care clinics provide the same services as emergency

rooms at a different rate.

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Figure 3. (America’s Debt Help Organization, 2019)

Walk-In Clinic Comparison

Both retail clinics and urgent care centers offer services that can mainly go without

scheduling an appointment with a primary care physician. Not all services done at urgent care

centers can be done at a retail clinic. There are limitations to which services each clinic can

provide. Retail clinics are staffed with nurse practitioners with limited privileges and urgent care

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clinics center staff board certified physicians. The chart shown in Figure 4 (Independence Blue

Cross, n.d) can help patients decide which clinic to use for those unexpected urgent cases.

Figure 4. (Independence Blue Cross, n.d)

Both urgent care centers and retail clinics in comparison to the primary care physician and the

emergency department offer the convenience of providing extended hours and target patients who

may have unscheduled care.

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Hospital System Partnership with Walk-In Clinics

Hospital systems have become a major stakeholder for the walk-in clinic market. Hospital

partnerships with clinics have allowed for opportunity to access better care coordination.

Receiving care at a hospital that is within the network of your healthcare provider and has been

the traditional model of seeking care. Hospitals that are affiliated and operating a clinic can provide

care to patients who would prefer to step away from visiting a physician’s office and emergency

department. When hospital systems create a partnership with clinics, the hospitals benefit because

retail clinics own and operate the facility and hospitals staff the clinics (Kaissi, Charland &

Chandio, 2013). With several hospital systems working towards opening retail clinics and urgent

care centers, the focus is on patient convenience and efforts to drive compliance and improve

outcomes. In Figure 5, the map shows hospital systems affiliation with retail clinics. The leader in

hospital system and retail clinic affiliation is MinuteClinic by CVS.

Figure 5. (Hennessy, 2016)

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 Recently, the CVS retail clinic chain has made a move to launch a partnership with Aetna,

a health insurance company that provides different insurance plans. With this partnership, Aetna

will be able to guide health plan enrollees to health and wellness services at CVS pharmacies and

MinuteClinics (Japsen, 2019). The integration of population management has allowed for a unique

role in patient engagement and to expand their scopes of practice.

Population health management has been introduced in the walk-in clinic market, allowing

for integrated roles to care for patient with chronic disease. CVS will start to test stores by adding

health services that will focus on population health management. Larry Merlo, President and CEO

of CVS Health has outlined a vision for the future of healthcare by focusing on reducing medical

costs for the company (Lavito, 2018). Each testing at the clinics will be a pilot of various programs

that will determine which are most effective across CVS locations.

Kaiser Permanente is another hospital system that is partnering with Target which is

focusing on expanding to deliver care at a lower rate and reducing physician waiting rooms.

According to PR Newswire, patient who utilize a Target clinic operated by Kaiser Permanente can

see care for the following: pediatric care; women's health care; monitoring and care for chronic

conditions including diabetes, cholesterol and high blood pressure; basic dermatology services;

and treatment for minor illnesses including strep throat, vaccinations, sinus pain, earaches, asthma,

and cold and flu. Target clinics are staffed with licensed nurse practitioners, licensed vocational

nurses and physicians available through telemedicine consultations.

Affordable Care Act

The ACA was necessary in the United States as a state of transformation in the delivery,

availability and affordability of care. The ACA was created to promote innovative medical care

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delivery methods that were designed to lower costs of care. The rise in the cost of health care was

seemingly high, and those without insurance or of low-income status could not afford the care.

The high cost of care would make preventative care unaffordable and those without insurance who

utilized emergency rooms put the cost at an even higher rate. In 2010, a report explored some ways

in reducing the future health care costs in New York. The report found that by expanding the roles

of retail clinics would help reduce health care expenditures by $350 million between 2011 and

2020 (Burkle, 2011).

There have been many challenges from the passage of healthcare reform, including a

shortage of primary care physicians. Since a shortfall of primary care physicians, patients are left

with gaps in their care. The physician shortage is predicted to worsen, and by 2025, there will be

increase of this shortage from 91,500 to 130,600 (Ferneini & Ferneini, 2015). The use of retail

clinics or urgent care clinics can help fill these gaps.

Under the ACA, we have seen a push for primary care services to meet the needs of

patients and improve efforts to bring care to patients who live in lower income and rural areas.

Since the passage of the ACA, demand for accessible primary care through retail clinics has

increased; between 2010 and 2012, 58 percent represented new utilization of retail clinic usage

and 93.1 percent represented a substitution of a physician’s office (Ashwood, Gaynor, Setodji,

Reid, Weber & Mehrotra, 2016). Healthcare reform has continued to bring new ways to deliver

care to those who seek care outside of the traditional healthcare model or the primary care

model. Healthcare reform has a strong influence on the rise of the retail clinic and urgent care

market.

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Healthcare Delivery Systems and Frameworks

The healthcare delivery system is a framework that guides healthcare professionals to

deliver care to the patient by treating and preventing a disease. The care is delivered by a licensed

and trained physician or nurse. Medical care can be covered by health insurance coverage or out-

of-pocket. The U.S healthcare delivery system is the world’s most advanced and most expensive.

Although the framework for the healthcare delivery system exists, it is a broken system where

consumers of care are often unable to seek medical attention because they are uninsured or lack

the expenses to cover the costs of care. Different frameworks are used to address access to care,

lower costs of care and to provide patient centered care.

The Triple Aim

The Institute for Healthcare Improvement created the triple aim framework to help with

translating specific actions for change within the healthcare delivery system. The Triple Aim

focuses on three critical objectives that would lead to better models in the healthcare delivery

system:

- Improve the health of the population

- Enhance the patient centered care experience and

- Reduce or control the per capita cost of care.

Retail clinics evolve to achieve the triple aim by addressing on how to focus on care

coordination and rethink how they do business. Heather Helle, a divisional vice president of

Walgreens said, “There’s an epidemic of obesity and chronic disease, an aging population, a

shortage of primary care physicians, and millions of newly insured Americans” (Sullivan, 2014).

Walgreens, which has been at the forefront on expanding retail clinics in various locations, sees

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that there are issues that can be addressed if they follow the triple aim framework. Walgreens

footprint is to further establish its health clinics can provide care to by extending access to care

and be at the center of the patient experience.

Traditional Healthcare Model

The traditional healthcare model requires patients to find in-network physicians who also

would have to fit the patients’ schedule to be seen. This framework focused more on quantity over

quality of care and the U.S. healthcare system centered its cash flow from fee-for-service payment

systems. After different legislation and policies have taken place, there has been more focus on

providing patient-centered and patient focused frameworks such as value-based care.

Value-Based Care

Value-based care shifts away from fee-for-service payment within the tradition healthcare

model to focusing on patient health outcomes and paying physicians or hospitals who provide care

based on value-based healthcare delivery models. The delivery of healthcare is transforming its

way to a different approach to care and integrating a new framework where the quality of care is

being transformed and given the proper care to patients.

Consumer-Driven Model

Retail clinics and urgent care clinics target a need in the market for consumer driven access

of treatment for minor health problems. The convenience revolution that is brought up by the walk-

in clinic market gives patients convenient options, which allow for treatment of simple acute

medical problems in which the convenience option that both walk in clinics provide. Before the

revolution, patients must wait to see a primary care doctor or go to the emergency room if they

wanted to seek care for low acuity conditions, such as rashes, bronchitis, or urinary tract infections.

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Regulatory Measures for Licensing of Walk-In Clinics

With the expansion of retail clinics across the United States, limited regulations and rules

are imposed on retail clinics. Government support is needed for the success of walk-in clinics.

Regulation and licensing would allow for more retail clinics and urgent care centers to expand

their scope of services. The Urgent Care Association of America and the American Academy of

Urgent Care Medicine have criteria for urgent care clinic that limit their regulation and state

licensing requirements (Urgent Care Centers, 2017).

State licensure and ownership requirements for clinics vary. Clinics are licensed as

physician practices and regulated by medical boards in some states (Tu & Boukus, 2013). The

increase in usage of retail clinics has caused some challenges for the states. Those challenges

include scope of practice issues, corporate practice of medicine laws, and reimbursement policies

(Takach, M. Witgert, K., 2009).

Although retail clinics continue to expand across the country, the nation’s medical

establishment questions the scope of the clinics and limiting on which services to provide. The

American Medical Association and other state chapters question if retail clinics would perform

procedure beyond their capabilities. Considering that patients will use walk-in clinics to meet their

medical needs, a challenge that may need to be face is the use of clinics fragmenting patient care.

They are also concerned if clinics detract from patients’ continuity of care with doctors who could

be left in the dark about patients’ medical histories and treatments.

Policy Limitations for Walk-In Clinics

The increase of urgent care and retail clinics has caused a shift to the healthcare market.

Although some medical associations are against the use of urgent care and retail clinic locations,

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consumers of care are pushing for the healthcare systems and policymakers to push for more

regulation and licensing.

The importance for policymakers to regulate walk-in clinics is to create better coordination

of care. Walk-in clinics are in need of universal standards where they can recognize the capabilities

of the care they can provide and stay within their scope of practice. Policymakers can take steps

to ensure that retail clinics have the same standards as hospital systems and other providers. The

rise of urgent care clinics and retail clinics can be a tremendous dynamic to the healthcare market

if it helps providers of hospital systems to have the date needed to serve the patients and the

community.

The Joint Commission accredits urgent care centers in its ambulatory care accreditation

program. Urgent care centers are accredited as community health centers or ambulatory care

providers. Accreditation will occur for urgent care centers once a true definition of what an urgent

care center is determined. There is some concern from payer networks on accreditation of urgent

care centers and defining what urgent care centers are and when the care of a patient leaves the

physician office to an urgent care center.

Payers prefer that urgent care centers have accreditation because it is awarded only to

organizations that have met national standardized criteria to provide high-level care and achieved

excellence (Lang, 2017). Payers expect that urgent care centers are accredited before contracting

and in order to remain in network. Accreditation is important for urgent care centers because this

will show proof of value and quality of healthcare services.

Accreditation is another example of what drives the use of clinic usage because it creates

a trust to the patient that the clinic has gone through various measures to have their clinic approved

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of delivering quality of care. Hospital systems see that clinics with accreditation and have a seal

of approval for providing convenient access to high quality, which drives for partnerships between

clinics and healthcare systems.

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 Methodology

This study is a qualitative analysis of archival research data on the emergence of retail

clinics and urgent care clinics, healthcare reform and/or the Affordable Care Act, regulatory

framework and credentials, and access to primary care vs retail health. The database systematically

searched for peer-reviewed journal articles and non peer-reviewed journals such as government

and healthcare websites that were published between March 19, 2009 and April 8, 2019. There

were thirty-five bibliographies that were found but twenty-nine bibliographies were used due to

the relevance of this research project. Articles were obtained by searching the CSUN library

database. The search engines that were used to obtain the articles were JSTOR, Science Direct,

ProQuest, GaleGroup, Gale Expanded Academic, and Google Scholar. The search terms that were

utilized were retail clinic usage, urgent care clinics, policy & regulatory implications, healthcare

reform, healthcare trends, frameworks of health care, and hospital affiliation with retail clinics.

The searching process through the database began in November 20, 2018 and concluded on July

19, 2019.

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 Findings/Analysis

Providers of care need to place their focus on better patient access to care and positive

experiences. Retail clinics operate by focusing on consumer-focused healthcare, where the prices

of services are offered firsthand, and patients receive the care that they expect to receive. In

addition, they are often referred to as being convenient because of their accommodating hours,

straightforward pricing, and no appointments necessary. Among patients who seek care at walk-

in clinics, they can expect to see a demand of rising health services that will be available.

Meeting the Demands of Consumer Driven Healthcare Delivery

Retail clinics and urgent care clinics have used healthcare business models that allow them

to deliver coordinated care. Each model has allowed walk-in clinics to rethink the way that the

delivery of care to meet the consumer driven demand, objectives of the triple aim model and

promoting value-based care. Although previous healthcare business models have influenced the

way walk-in clinics function – retail clinics and urgent care clinics have made their own form of

business model.

Retail clinics and urgent care clinics operate by being influenced by other healthcare

business models, but their model of convenience has attracted patients. The operation of walk-in

clinics has continued to expand their scope of practices that meet more than just the patients’

primary and urgent care needs. The walk-in clinic market continues to prove that the will push to

be of the healthcare continuum and give patient what they want and that is convenience to care.

Patient Preferences for Clinic Usage

Location of walk-in clinics have allowed for patients to access care near to where they live.

About one third of the U.S. population lives within a ten-minute drive of a retail clinic (RAND,

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2016). This makes access to a clinic much easier than going to a primary care physician. The

American Academy of Pediatrics encourages their members to provide care in a convenient time

frame and location variation as part of the medical home (Dalen, 2016). Users of retail clinics are

more likely to not have a relationship with a primary care physician.

Retail clinic users provide care to a large number of young adults, minority families, and

families with children (RAND, 2016). Their reason for such use is because of convenient hours

offered, low costs, short wait times, transparent pricing and dissatisfaction with primary care

(RAND, 2016). A survey from 2010 found that the 59% of retail usage was for the convenience

of the hours, 56% said it was because no appointments were required and 48 % said it was because

of the location (Ollove, 2016).

Challenges and Barriers

Regulatory measures for retail clinic and urgent care clinic usage have their challenges.

Many who are opposed to the use of walk-in clinics believe that it is disruptive to the patient-

physician relationship that is strengthened when a patient sees a doctor during an office visit. If a

patient seeks care at a clinic a handful of times and does not send their medical records from the

clinic visit to a primary care physician, then the medical record of the patient in not kept. Patients

must take the responsibility that if they seek care at a retail clinic or urgent care center, they must

keep a record of past visits and immunizations so that care can be better coordinated.

About 30% to 60% do not have a relationship with a primary care physician (Dalen, 2016).

Not having a primary care physician can make care coordination problematic. Since the passage

of the ACA, more Americans have gained health insurance, but the shortage of physicians has

cause booming wait times at physician offices and emergency departments. Patients who are

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unable to seek care with primary care physicians will be unable to have a relationship with a

primary care physician. Having a strong relationship with a primary care physician will allow for

patients to feel comfortable and to follow their care plan. If patients use a retail clinic or urgent

care clinic, they may not have the opportunity to build relationships with nurse practitioners or

physician assistants.

Recommendations

With the increase of walk-in clinics across the United States and hospital systems merging

into operating retail clinics and urgent care centers, further research is warranted to determine how

they are collecting patient data and turning it to coordinate better care. Partnerships between walk-

in clinics are creating the opportunity for other healthcare providers to gain an understanding of

other ways to deliver care. More retail clinics and urgent care clinics must integrate the use of

electronic medical records to maintain patient records and to make health data interoperable among

other hospital systems. Influenced by innovation and building a platform between patients and

their primary care, the use of EMR systems in retail clinics will allow for coordination of care.

Epic Systems are available at Walgreens retail clinics, allowing for shared information with more

than 26,000 clinics and 1,200 hospitals (Bresnick, 2017).

The integration of EMR’s caters to the patient healthcare experience. The patient healthcare

experience ranges from the interaction with the healthcare system, healthcare providers, and their

care from health plans and other health care facilities (Agency for Healthcare Research and

Quality, 2017). Further data should be collected to show that the use of EMR by retail clinics who

have integrated it into their systems has provided better coordinated care. Walgreens has the

opportunity to provide interoperable work to ensure that patient information between the

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pharmacist and clinicians are under the same umbrella. The use of Epic Systems is a tool that has

helped deliver to the consumer- driven focus of healthcare delivery.

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 Conclusion
Since the emergence and growth of retail and urgent care clinics, we have seen their model

of care respond to the demand of patient convenience. The walk-in clinic market can provide better

care coordination and further increase their usage by meeting the demand of the patient care needs.

When a physician’s office is unable to get an appointment in the next few days or when wait times

at emergency rooms are long, patients turn to walk-in clinics to receive care.

The Affordable Care Act has influenced many healthcare providers to develop was to

providing better healthcare delivery systems. Traditional healthcare models has given limited

opportunity for patients to seek care outside of their hospital systems and coverage of health

services entitled them to a limited co-payment. Many walk-in clinics give patients who prefer to

pay out-of-pocket and get the care they need when they want meets the demand of consumer driven

health care.

Consumer-driven healthcare has allowed for hospitals systems and clinics to partner, which

gives patients the same amount of care without filling up physician offices or emergency rooms.

Consumers of healthcare receive care at walk-in clinics because of the convenience, low cost and

accessibility. The services of both clinics give primary care an urgent care that will offered at a

lower rate and more accessible.

25
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