Introduction and Context
[00:00:00] Stacey Richter: Take two. Sidebar.
Retail Clinics: An Overview
[00:00:02] Stacey Richter: "Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well in His Opinion." Here's a short clip from my conversation with Dr. Tom Lee a year ago.
To listen to this episode or read the show notes with mentioned links, visit the episode page.
[00:00:29] Stacey Richter: I clipped out this five minute sort of sidebar conversation with Dr. Tom Lee when I was speaking with him last summer that I thought you might be interested in listening to by itself, because it is a bit of a, like I said, a sort of a tangent.
And again, given all of the conversations that we've been having lately about trust and mission and margin, I think the points that Dr. Tom Lee makes in the conversation is all the more relevant.
My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
I'm definitely gonna loop back on some of other ways one becomes an enlightened leader who has a value-based mindset.
Challenges Faced by Retail Clinics
[00:01:09] Stacey Richter: But before I do reconcile for me, you know, the hypothesis that Walmart had and Walgreens and some of these other, let's put a clinic inside a place our customers/patients/members already are. That is gonna be great access. Right? Like they're already in the Walmart so they can just pop by and get some medical service.
And you said this, you said access is going to be an important metric, but not the only one. Talk a little bit about the experience maybe that some of these clinics found out the hard way.
[00:01:43] Dr. Tom X. Lee: Well, I mean, let's call it the retail clinics, just broadly speaking, which has, you know, been a 20 plus year concept in general and has failed to what we call really, truly deliver great longitudinal primary care.
They've been convenient vaccine shops and you know, what I call minor urgent care type of clinics, but very few have really become longitudinal primary care destinations.
The Importance of Longitudinal Care
[00:02:08] Dr. Tom X. Lee: And that's the key difference, right? Access is different from somebody who knows me and can manage my care longitudinally as a true primary care provider, most of the retail clinics are really servicing, as you know, other versions of urgent care, which there are plenty of, with plenty of access.
And so in the absence of what I call longitudinal access, there are convenient options out there that are transactional if need be, right, including the ER. They aren't the best places to get your care necessarily, but those are other access points. And so the second point is really who is on the other side and what are they doing for me at this location?
Economic and Operational Hurdles
[00:02:47] Dr. Tom X. Lee: There's a separate issue of just the economics of this when it's not your core business to run a service operation, it's hard to stand up a service operation. And I think people don't realize that service operations aren't a second job. They should be your first job. And I think people tended to underestimate, and I think still do how hard it is to run a service operation, particularly within primary care.
[00:03:11] Stacey Richter: Yeah, I mean I have heard that in Walmart, just to echo at this point, they were looking at the square footage the clinic was taking up and deciding they could make more money selling tires in that same square footage. So there's all kinds of issues that were going on there.
But from what I'm hearing, if we're thinking about what is a value focused mindset, that one of the first things to figure out, like what are you trying to accomplish and what does that look like?
And you're highlighting the idea of access as a proxy for some performance metric. But you also need to be really contemplative of how do you become a longitudinal care destination. It sounds like that's kind of like high on your list to really think through what is a longitudinal care destination. What does that look like?
I mean, probably relationships, right? That seems to be a thing in and of itself that you sort of have to get right?
Defining Primary Care and Its Promise
[00:03:56] Dr. Tom X. Lee: Yeah. I mean, it all depends on how you define primary care and for what reason. The reason why people like primary care conceptually is in theory, again, it offers a better way to get value for your dollar in care.
That's true if primary care is delivering on its promise. Today, it's not delivering on its promise because it's been obviously low reimbursement and high complexity overhead have really diminished the capabilities of most primary care offices in general. But if you were to say: “Hey, primary care's purpose is to be a general place of care, longitudinally, to handle most issues, that's the promise of primary care.”
I think that's very different than a MinuteClinic or some transactional system that's focused on convenience. And so that second dimension that we talked about after access is important, and that is where the economics really struggle.
You know, open access is somewhat of an operational problem that doesn't cost dollars. That just costs management discipline. You know, open access is a concept that's been based around for 20, 30 plus years. You just have to execute it. Not many organizations execute open access.
The second dimension is running a longitudinal primary care practice in a cost efficient manner given the reimbursement architecture. And that is challenging and what you include in the scope of primary care, not just kind of the label, but the actual content matters and how you do it matters.
And so that's where the service complexity starts to really take hold. And I think people tend to not really understand what that means in a traditional environment.
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