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    NONFOODS: Pharmacy Series: In-store Clinics: The full treatment

    In-store clinics are helping grocers give the 'one-stop shop' critical new meaning.

    Here's a familiar scenario: You wake up with a fever and sore throat. It's bad enough to keep you home from work, but not so bad that you feel you must run to the doctor. Besides, last time you felt this way, the office was booked solid and you couldn't get to see him or her anyway.

    Still, you need treatment, and OTC isn't going to cut it. You could just climb into bed and stick it out -- or increasingly, you might be able to head to the local supermarket and visit the in-store clinic, where the nurse practitioner could examine you, and perhaps prescribe some antibiotics that you could pick up in the supermarket pharmacy adjacent to the clinic. And you could even grab some store-made chicken soup on the way out.

    It's just such a new scenario that has made convenient care clinics (CCCs) a fast-growing trend in the retail food landscape. The convenience, speed, and quality of care -- not to mention lower costs for the uninsured -- have made this concept a natural fit to enhance the supermarket one-stop-shopping experience.

    Already, a growing number of retailers have installed these clinics at multiple locations, including Schnuck Markets, Inc.; Wal-Mart; HEB; and Weis Markets, each of which has plans to expand these services to additional stores this year.

    "It's about access," says Web Golinkin, c.e.o. of Houston-based RediClinic, which has units in several HEB supermarkets and plans to have 35 up and running within the chain by the third quarter of 2007. "It's located in a convenient place. It's a new reason to visit the store. Consumers can get in and out in 15 minutes -- and can get their prescription filled in the same location."

    Indeed, these clinics can be an ideal complement to a retailer's pharmacy services. "The clinics will strengthen Schnucks' pharmacy offerings, and complement education and counseling services already in place," says Mike Juergensmeyer, v.p. of general merchandise and pharmacy for the Midwestern chain.

    According to the Philadelphia-based Convenient Care Association (CCA), a newly formed trade organization for clinic providers, there are currently an estimated 200 CCCs throughout the United States in food stores, drug stores, and other retail settings with pharmacies.

    Each unit generally ranges in size from 200 to 500 square feet, and is outfitted with all the necessities of an outpatient health care office. The operations can vary from one exam room to multiple rooms with sinks and exam tables.

    "We have a 250-square-foot format that is used for pharmacies and small supermarkets, and a 600-square-foot unit which we build for Wal-Mart Supercenters," notes RediClinic's Golinkin. "Each has nurse practitioners providing care, as well as health educators who provide assistance and handle the administrative work."

    Ownership structures for the CCCs vary. Some are privately held, while others are run through local or regional health systems or nonprofit organizations.

    Most have a medical director involved at the highest level of the organization, and some have nursing leadership as well. Several of the leading CCCs have both medical and nurse practitioner officers, who work collaboratively overseeing the medical scope of practice and quality of care.

    "People know that they can get good care for common medical problems at clinics, without the wait and expense associated with urgent care and emergency rooms," says Dean Q. Lin, c.e.o. of CareWorks Convenient Healthcare, which is a service of Danville, Pa.-based Geisinger Health System, a nationally known provider.

    Care at most CCCs is provided by a nurse practitioner (NP), who is authorized to work independently of a physician and can provide most primary care functions, including writing prescriptions (see sidebar below). In a CCC the NP focuses on taking care of everyday family illnesses such as strep throat, mononucleosis, ear infections, and rashes, while also providing patient education, health promotion and prevention services, and referring patients to an appropriate level of health care if necessary.

    Many clinics provide vaccinations, health screenings, and physicals. If a patient has a condition that falls outside of the provider's scope of practice and/or the scope of the CCCs, the patient is referred back to a primary care provider or given direction as to where to get appropriate services for the illness. If a patient doesn't have a primary care physician, the clinic staff will provide a referral list and advocate the need for a doctor.

    Most clinics have relationships with local physician groups, NPs, nurse-managed centers/practices, community clinics, and hospitals. Using these relationships, NPs can consult with and refer patients who need immediate care and treatment, regardless of socioeconomic and health insurance status.

    "Most states require NPs to work in collaboration with a physician," says Golinkin. "All of the states we're in are like that."

    Many clinic operators have partnerships with major insurance carriers, or are working to contract with them. RediClinic locations covered under the UnitedHealthcare agreement, for example, include seven locations in HEB stores in Houston, Austin, and San Antonio, Texas, as well as four locations in Wal-Mart stores in Tulsa, Okla. and Fayetteville, Ark. UnitedHealthcare members can avail themselves of the services at these clinics for the price of a co-payment.

    Retailer benefits

    Retailers hosting CCCs benefit in numerous ways, aside from the obvious gains in rental income and foot traffic. A symbiotic relationship develops between the clinic and supermarket -- one that's not a formal partnership, but nonetheless produces tangible dividends for the grocer.

    The industry term is a "collegial relationship," says RediClinic's Golinkin. "The same organization can't own both the clinic and the pharmacy, so there's an arm's-length relationship between them. It has something to do with the [avoidance of] self-referrals. Customers must be able to decide where to get their prescriptions filled."

    With the supermarket pharmacy adjacent to most clinics, however, deciding where to pick up their scripts is a no-brainer for most patients, and often results in a new pharmacy customer for the supermarket. And pharmacy customers are often extremely loyal.

    "We see this as a win for the consumer and the supermarket owner," says Tine Hansen-Turton, executive director of the CCA. "The clinics are a wonderful way for supermarkets to focus on wellness and nutrition products. Furthermore, the connection with the pharmacy and pharmacists is critical, since many shoppers will be able to get their prescriptions filled immediately."

    The rest of the store benefits as well. NP recommendations can also include advice on dietary needs, and that's where the food side of the store comes into play.

    "There are a number of promotional concepts that CareWorks is developing with Weis Markets, which will leverage our unique role in the retail setting," explains CareWorks' Lin. "CareWorks is big on marketing its services to the community, schools, and local employers, and will also leverage retailer-sponsored marketing channels to connect with customers via newspaper circular and in-store radio, for example."

    Both the retailer and the clinic must be involved in promotions for the relationship to be a successful one, says Ronald Bucci, president and c.e.o. of Akron, Ohio-based QuickClinic, LLC, which operates units in two Acme Fresh Markets, and a Buehler's in Wadsworth, Ohio.

    "Cross-promoting is essential to a successful clinic," observes Bucci. "The retailer needs to include the clinic on promotional items such as weekly flyers, promotions, and other written materials. The clinic needs to include the retailer on its promotions to give the clinic credibility and extend the trust shoppers have in the supermarket to its operations."

    To help reinforce this trust, the CCA is developing standards and clinical guidelines for the industry through its Clinical Advisory Board, which is made up of member health care providers and industry stakeholders. The confidence exhibited by the food retail industry so far, as demonstrated by the concept's rapid development, should go a long way toward building this trust.

    "The model is evolving -- it's an ongoing program," says RediClinic's Golinkin. "We went from trailers to in-store units, and are now represented by a trade association. The convenient care industry is definitely moving forward in a really positive way."

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