punctuative! by Matt Winn

Quick service health clinics have recently been making headlines and they’re worth a hard look if you’re interested in healthcare (hint: if you’re interested in self-preservation, you should be interested in healthcare because the economics of the system aren’t always in your body’s best interest).

The concept addresses a resource allocation inefficiency: a majority of visits to the doctor are made for mere colds, flus, poison ivy rashes, and the like, yet doctors treat these in the same 7-8 minute appt that they treat any other malady. Doctors’ time is expensive, service quality and cost is relatively hidden to the consumer, and the uninsured have nowhere to turn but the hospital so they wait until care is critical. Quick service health clinics turn that paradigm on its head. They lease space in highly-trafficked stores - pharmacies and big box retailers - and charge $40-$50 on average for a nurse practioner to administer care for a small set of common ailments. Waits are short, prescriptions are down the aisle if the clinic is in a pharmacy, and service is reportedly excellent.

Large chip stacks have already been bet on a number of these providers, include RediClinic out of Houston, TX, which Steve Case’s Revolution Health has invested in, and the largest provider, Minneapolis, MN-based MinuteClinic, which announced its aquisition by CVS in July.

A noteworthy announcement surfaced today, however, in the St. Louis Business Journal concerning Take Care Health Systems, another frontrunner in the space, that helps paint the complexity of quick-service business. Physicians and others have leveled criticism at such clinics, not only from the standpoint of concern that more complex illnesses could be overlooked by nurse practioners, but also that the business arrangement between a clinic and its pharmacy landlord creates a conflict of interest (creates incentives for the clinic to push pharmaceutical treatments). Take Care Health had made arrangements previously in the year for St. Louis-based SSM Health Care, which operates 20 hospitals, to provide “collaborating physician review services,” according to the article. That sounds like a good stop-gap to catch ailments outside the purview of the clinics, but this week the relationship was called off:

Mainly, the decision was about “listening to and respecting the concerns of our doctors,” Kiesel [SSM's spokesperson] said.

Sounds to me like the lawyers are talking. Remote outsourcing is well documented for imaging review, but for a physician to remotely assess a case without standard diagnostic tools sounds like an enormous liability. I wonder if other clinics are trying physician backstop models as well.

For me, the quick service clinics point to the tip of an information services iceberg-sized problem in healthcare today (that I expect a digital media company to one day solve). Doctors are trained as complex algorithms - ready to take a series of inputs and deliver an output - in order to care for patients. Simple cases shouldn’t require a highly-paid “consultant.” Unfortunately, though, the vast majority of the domestic population, even the most well educated, are entirely unaware of preventative health best practices. As a result, the common cold may often be a symptom of a larger problem.