Specialty Clinics

By Jim Poggi

Retail, urgent care and other specialty clinics are expanding their service offerings

With the need for improved access to care, lower costs and to provide more transparent pricing to healthcare customers, several types of specialty clinics have come to market in the last 20 years or so. We’re all familiar with retail convenience clinics, urgent care clinics and stand alone emergency medicine clinics. But what’s changing and what’s new? I will share my observations on the established patient care settings and some emerging types of clinics, and offer some thoughts on where the future of specialty clinics is leading and why.

Legacy specialty clinics
The listing of privately held legacy clinics in the sidebar is organized by increasing breadth of health care services typically offered by each clinic type. Community health clinics and governmentally funded clinics are not included in this listing.

Clinic Type	Conditions treated	Tests and services performed	How they position their customer benefits
Retail convenience clinics	Minor injuries, sudden minor symptoms, respiratory conditions, SOME chronic disease management and immunizations.	Flu, strep, urinalysis, hCG, glucose, BMP/CMP. SOME A1C and lipids. Mostly CLIA waived labs.	Convenience: Over 2,800 locations in U.S. in drug stores and other large retail outlets serving over 6 million patients. Long hours (typically early morning to late evening). Transparent pricing and little to no wait to be seen. While they began by treating “skinned knees and runny noses,” many now offer immunizations, wellness and chronic care services. They’re often associated with retail pharmacies. Trending: coordinating immunizations and pharmacy services to promote wellness and health screening services.
Urgent care	Minor injuries and most typical respiratory conditions. Sudden onset of pain, bleeding or other relatively minor symptoms.	Flu, strep, urinalysis, hCG, CBC (some), mono, glucose, BMP/CMP. A higher proportion of CLIA moderate labs than retail convenience clinics. Many have X-ray and prescription services	Availability: research indicates there are over 7,000 urgent care clinics in the U.S., with over 160 million visits annually. They offer extended hours compared to primary care practices, and a broader range of services and clinical expertise compared to retail clinics and equivalent short wait times. Eight of the top 10 urgent care chains are privately owned. Larger physical footprint than retail convenience clinics. Trending: service expansion includes occupational health and drug screening.
Stand-alone emergency rooms	Their service range claims mirror hospital-based emergency rooms. Coverage hours are 24/7 in most cases. This includes acute care, imaging and lab services.	Research indicates their lab service level focuses on acute respiratory, cardiac and injury related (CBC) tests. They tend to be CLIA moderate rather than waived.	Proliferation of stand alone emergency rooms began in the Texas area and has spread quickly. Their claim is hospital service levels with locations more convenient to their patients. Trending: wait and see whether these clinics continue to acquire patient visits and how far they spread geographically. What will hospitals do?

Men’s health and women’s health clinics
As I started looking into the changing face of patient care options, I began to realize that “men’s health” and “women’s health” clinics appeared to be experiencing the most dramatic changes to their service offerings, positioning in the healthcare system and their overall appeal to patients. Unlike the legacy clinic types, these clinics tend not to treat acute health care conditions or even a wide range of clinical conditions. In the early going, they focused on “sexual health”: diagnosis and treatment of fertility, erectile conditions and sexually transmitted diseases. Their patient demographic tended to be patients in their middle years with private health insurance coverage who wanted to understand, maintain and/or improve their sexual vitality. Geographically, they have tended to be located in suburban areas close to their target patient population. Their service offering historically did not compete with hospital or primary care practices.

So, what has changed in these clinics? Their service offerings have continued to expand and their current customer value proposition has migrated from sexual health to overall health, youthfulness and vitality. With the recognition that overall vitality improves athletic, sexual and even intellectual performance, many of these clinics now offer a broad range of vitality services and options. These services tend to include appearance and aesthetic treatments.

In many ways, their story is about extending physical vitality and youthful appearance later in life than previously possible without medical treatment. Cornerstone treatment options include bio-identical hormone replacement therapy to increase estrogen, testosterone, and other hormone levels to levels more likely to be found in younger adults (20-40 years). Their assessment program involves testing hormone levels (usually send out testing), attitude and well being patient surveys, and customization of programs to help the patient improve vitality and appearance in their desired areas. Weight loss, sexual vitality treatments and counseling along with personal appearance services are all part of their growing portfolio of services.

The median age in America today is 38, and increasing annually, which creates a potential market for these clinics and services. What does their expanding service level, public awareness and appeal mean to primary care and hospital based clinical practices?

From an overall health maintenance perspective, while these clinics tend to be more focused on overall vitality than in previous years, they don’t tend to treat the chronic health conditions (cardiac, cancer, stroke and diabetes) that are encountered daily in primary care and end up in hospital emergency rooms. So from a chronic care and acute intervention viewpoint, they’re not competing with our established clinical customers. They are supplementing vitality offerings and competing for health care spending, particularly discretionary cash spending of the more affluent health care customers.

Additionally, the number of wearable devices available to monitor pulse rate, exercise and other vitality metrics has gone mainstream in recent years, creating substantial awareness of vitality assessment and monitoring. As a result, some forward thinking hospitals and larger primary care practices are beginning to add some of these vitality services to their options.

I expect this trend to continue and, unless hormone replacement therapy is found to create unhealthy side effects, it appears there is an emerging “vitality” market. What remains to be seen is whether the vitality market will continue to grow, and which clinical settings will lead the way.