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Tighter Integration of CVS' MinuteClinic with Chicago's Advocate Health Care

Posted Apr 12 2011 12:00am

There has always been some challenges associated with the business model for walk-in clinics located in retail pharmacy chain stores. Commonly staffed by nurses, they were only prepared to deal with minor health problems and routine procedures. This approach often did not generate enough business. Therefore, some began to place physicians in these clinics who were then able to treat more significant health problems. Once some of these clinics started in this direction, it made sense to contract with local hospital systems to both provide physicians and also to integrate the clinic records with those of the health system. This provided a referral network for the more seriously ill patients who were being turned away from the nurse-staffed clinics.

The Cleveland Clinic was an early participant in this new business model with MinuteClinic, the retail healthcare division of CVS (see: Cleveland Clinic Partners with Minute Clinic in Retail Health Services ). MinuteClnic is now modifying their business model in the Chicago area in collaboration with Advocate Health Care (see: New Affiliation Between MinuteClinic and Advocate Health Care Increases Access to Medical Services in Chicagoland ). Below is an excerpt from the press release:

[This] is the largest clinical collaboration between a regional health system and MinuteClinic based on number of in-store clinic locations. Under the agreement, physicians affiliated with Advocate Physician Partners will serve as medical directors for MinuteClinic's 23 locations in the Chicago metropolitan area and in Bloomington, Ill.  In addition, MinuteClinic and Advocate Health Care will collaborate on patient education and disease management initiatives and will inform patients of the services each offers. Where appropriate, Advocate Physician Partners physicians can accept patients who need a higher level of care than MinuteClinic can provide. Signage at MinuteClinic locations will inform patients that each site has a clinical affiliation with Advocate....MinuteClinic medical clinics in Illinois are open seven days a week, including weekday evening hours, and are staffed by nurse practitioners who provide treatment for common ailments and administer wellness and prevention services and health condition monitoring...."This partnership allows Advocate physicians to provide a medical home for the many patients who seek care at MinuteClinic and do not have a relationship with a physician. It also aligns with AdvocateCare, our new transformational approach to health care delivery, which provides better coordination and transitions for our patients, [said an Advocate spokesperson]"....MinuteClinic and Advocate will fully integrate their electronic medical record systems to streamline communication around all aspects of each individual's care. With patient permission, each MinuteClinic will share medical history and visit summaries with other Advocate and MinuteClinic locations in the region.

There are some novel aspects of the standard, walk-in clinic business model that emerge in this Advocate/MinuteClinic press release. I emphasize them below:

  • The clinics are staffed by nurse practitioners but Advocate physicians serve as medical directors of the facilities. Patients requiring a "higher level of care" are not turned away but rather referred  to one of the Advocate facilities.
  • in addition to handling routine, minor problems, the clinics and Advocate will focus on "patient education and disease management." i suspect that this will include the ongoing management of chronic conditions such as diabetes and perhaps even obesity, both common problems. Nurse practitioners are often more willing to spend time with patients than physicians for these conditions (see: Most Physicians Unable to Treat Obese Patients or Even Raise the Issue ). 
  • Of great interest was the reference to these walk-in clinics as the medical home for some patients. In my opinion, Advocate/MinuteClinic are taking some liberties with the use of this term. Many people, I think, would consider an on-site physician as a minimal requirement for a medical home. A nurse-staffed walk-in clinic would not suffice. However, it's possible that such a clinic that closely collaborates with physicians might meet the requirement.
  • Also note the emphasis on the integration of the MinuteClinic medical records with those of Advocate. This will provide continuity of care for all patients, particularly the sicker ones who are referred to an Advocate facility.
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