The Expansion of Retail Care Clinics & FemTech
Written by Jillian Levovitz, MBA, Chief Strategy Officer, FemHealth Insights.
For several decades now, the US healthcare system has been actively trying to shift its focus from a care model focused on treatment to one focused on prevention. There is general consensus that preventative care can forestall or at least delay the onset of many chronic conditions, improve patient outcomes, and result in improved financial metrics such as cost savings and improved productivity.
In an effort to support this shift, private insurance companies are required to cover the full cost of many preventative care services for their patient populations including co-pays.
Unfortunately, despite this, preventive services are still severely underutilized in the US. A recent Ispos survey found that almost half of American women skipped a preventive care visit or health service in the past year. The Alliance for Women’s Health & Prevention breaks it down further, reporting that 27% of women have not seen a healthcare provider for a checkup or well-woman visit in the past two years and 23% of women are overdue for a cervical cancer screen.
When asked why they were not receiving preventative care 25% of women cited a lack of provider availability and 11% faced scheduling difficulties. Surprisingly, despite 89% of the survey respondents having health insurance, 23% also cited high out-of-pocket costs as a reason for missed preventative care.
Retail Care Clinics
This lack of provider availability has seeded the successful development of retail clinics throughout the US. Retail clinics are those housed in a retail location such as a pharmacy or grocery store (i.e. Kroger, Walmart, Walgreens & CVS) and have historically provided brief same-day visits with an advanced practice practitioner (APP) to treat an acute complaint. They offer availability and flexibility while being less expensive than treatment in either the emergency room or urgent care setting.
Unlike urgent care locations though, retail clinics have recently identified the unmet need for preventative care availability and convenience and have begun expanding their care offering to treatment beyond acute conditions with the intent of further growing into the primary care space.
In the last several months, we have seen significant investment to accelerate this growth with expansion in the number of retail care service locations and the variety of services being offered.
In late 2022, Walgreens invested $5.2 billion to establish their retail clinics in over 30 US markets with a goal of 600 new locations by 2025. Then, just this past week we had the announcement of CVS’s $10.2 billion acquisition of Oak Street Health’s 169 senior care clinics located across 21 states.
This physical expansion effort allows for higher patient volumes while also supporting the addition of chronic and preventive care services. For example, CVS minute clinics have grown to provide annual well visits as well as diagnostic and monitoring evaluations for a variety of conditions that range from cardiovascular to musculoskeletal and neurological health.
This vertical and horizontal growth offers exciting opportunities to expand access to care throughout the US. Only a third of the patients treated in retail health clinics report having a primary care provider (PCP), which generally means that if they weren’t receiving preventative care in this care setting, they likely wouldn’t receive it at all. The lack of PCPs is especially interesting because at least two-thirds of patients treated in retail clinics are reported to have insurance coverage.
Specific Considerations for Female Health & Wellness
Females currently account for 50% of the patients treated in retail healthcare clinics and a recent survey found that females are 20% more likely than males to trust nurse practitioners — making them more comfortable seeking care in this setting.
Many of the retail health clinics have also begun offering fairly comprehensive services for females such as annual “well woman” visits, birth control consultations and evaluation and treatment for urinary tract, bladder, and yeast infections to name a few.
Retail care clinics are providing important benefits to patients with expanded access to care at lower costs than alternative care settings. That said there are still challenges with this care model in its current configuration including concerns regarding both the quality and consistency of care provided. There are also questions about how to ensure continuity of care and potential difficulty with referring patients to specialists when warranted.
For female patients, there are also sex-specific considerations to account for. Many conditions that differently and disproportionately impact females may present with symptoms unique to females such as cardiovascular disease and ADHD. If providers are not trained to recognize these symptoms, it can lead to late or misdiagnosis.
There are also conditions that solely impact females, which can be difficult to diagnose or that generalist providers are not even aware of such as endometriosis. If retail clinics are moving toward providing well-woman visits and gynecological care, they should be trained to identify these conditions and understand sex-specific differences in presentation.
Overall, there are numerous ways to address these potential challenges inherent to the retail clinic care model. Existing FemTech capabilities can be leveraged to build detailed care pathways that can be programmed into EHRs and we are seeing the development of more female-specific ‘smart’ diagnostic tools as well as those that can be programmed to account for sex differences.
The reality is that many women currently experience delayed diagnosis or misdiagnosis even when evaluated by specialists, including women’s health specialists. Therefore, diagnostic challenges shouldn’t prevent the expansion of care options. Furthermore, although it may not be perfect, care in a retail clinic is arguably better than no care at all.
As these clinics continue to grow their footprint, there is also the opportunity to expand beyond generalist providers and bring on more specialized advanced practice providers (APPs). With the physician shortages that we are seeing in the US, the argument could be made that a sustainable healthcare model will need to depend on APP’s and non-traditional delivery. It makes sense to support and strengthen these alternatives.
Overall, the retail care setting has the potential to offer many opportunities to improve access to care and to help facilitate the US healthcare system’s shift from treatment to prevention. The focus should be on optimizing care in this new setting, empowering advanced care practitioners to provide comprehensive, sex-specific, care, and exploring digital health and FemHealth innovations that solve quality of care challenges and enhance continuity of care.
Female-Focused Non-Traditional Care Delivery
Although there are not currently any retail clinics focused exclusively on female health and wellness, there are companies working on expanding access to in-person exams and same-day visits with female care providers:
Between -Same and next-day in-person gynecology care from top-rated clinicians.
Plan A Health - Mobile clinics bringing health care directly to underserved communities, with an emphasis on improving sexual and reproductive health.
Betty’s Co. - Access to gynecology, mental health, and wellness care in a boutique mobile clinic.
Special Mention
CVS Health - We also want to thank CVS for their many women’s health initiatives including offering comprehensive care for females in their retail clinics, reducing the price of period products, covering the tax on period products in states where they are taxed, and removing the ‘pink tax’ from products for women.
About the Author:
Jillian Levovitz, MBA, is an experienced healthcare executive, the Founder, and CEO of OcciGuide, and Chief Strategy Officer at FemHealth Insights where she is responsible for consulting and research projects.
