BrainTrust Query: Are retail walk-in clinics a cultural challenge or opportunity?
By Terry J. Soto, author of Marketing to Hispanics
A recent WSJ article entitled, The Informed Patient: The New Force In Walk-In Clinics talks about the growing presence of these quick-treatment facilities in supermarket
and drug retailers across the country. Interestingly, the concept, common in Latin America, is already appealing to many U.S. Hispanics who lack a primary care physician relationship
or, more notably, healthcare insurance.
According to an October 2004 article entitled Trends in Health Insurance Coverage and Access Among Black, Latino and White Americans, 2001-2003, only 67 percent of Hispanics have health insurance, compared to 81 percent of African-Americans and 89 percent of non-Hispanic whites.
This has not gone unnoticed by Hispanic Physician entrepreneur groups, which have been opening and operating clinics in Hispanic neighborhoods for over a decade. The appeal of walk-in clinics among Hispanics is broad, even among those with insurance:
- Walk-in Care – culturally, Hispanics seek medical care as a last resort and typically when symptoms or conditions are serious, so appointment-free care, even with long waits, is preferable.
- Lower Costs – clinics better align with Hispanic communities’ incomes and the economic pressures of large families.
- Culturally Relevant Care – Hispanic clinic staff understand that most Hispanics are not oriented towards preventative health maintenance, that they often turn to home remedies or even healers as a first line of treatment and that, typically, seeking out medical care is a last resort.
- They Speak Spanish – probably the biggest draw to neighborhood Hispanic clinics. A recent study indicates that only half of Hispanics understand doctors’ instructions after leaving the office and that 50 percent of Hispanics will not go to a doctor because they feel they won’t be able to communicate with the doctor or nurses.
It would seem that walk-in clinics would be a natural fit for Hispanics and a huge draw for retailers. After all, these retailers/clinics are already in the community, offer cash-based and insurance-covered services, provide routine care, children and adolescent health services, diagnostic testing and vaccinations. Further, they cost less than half that of a regular doctor’s visit and can save equally on other related costs, such as lab services.
Discussion Question: Will retailers pick up on the cultural relevance of walk-in clinics for Hispanic communities?
It is expected that, by the end of the decade, the number of on-site clinics will grow nearly ten-fold to 10,000. Already, retailers such as CVS with 6,100
retail outlets have agreed to acquire MinuteClinic, which currently operates 83 clinics in retail outlets. RedicClinic, which has 75 clinics in stores such as Wal-Mart, Walgreens,
Duane Reade and H-E-B, plans to open 500 new units by 2009.
AtlantiCare Clinics will offer tips for healthy grocery shopping, and is talking to ShopRite about offering nutritional tours of supermarket aisles and
food labeling for healthy diets.
The big question is whether clinic groups and their retail partners will better align their operations with the needs of Hispanics, as they expand into
Hispanic communities. This will determine whether or not this seemingly natural fit can and will be leveraged by the mainstream retail community.
It will depend on the overall Hispanic market efforts made by the chain. If the chain has tailored its busines/stores/offerings/advertising to attract Hispanic consumers, walk-in clinics could be a great addition to what is already being offered. However, as we all know, many retailers have still not done much to attract Hispanic consumers. I would not really recommend walk-in clinics as the first way to reach out to a Hispanic consumer, unless they are installed at the same time that a comprehensive Hispanic market program is implemented. That being said, walk-in clinics are a GREAT idea, if consumers can be served in their language of choice.
I think that walk-in health clinics associated with retailers offers real opportunity – and not just for Hispanics. Smart retailers, especially pharmacies and those with pharmacy operations as part of their in-store operations, should already be tracking this concept very closely and/or looking at some type of test. As others have pointed out, many families are underserved in terms of health care. Latinos have a tradition of going for health service at neighborhood (walk-in) clinics so this fits well with their cultural experience. A new approach that offers simple, direct and convenient health care, and in the customer’s language of choice can’t help but be a winner. There will be a myriad of issues to cope with — legal, traffic, separating the walk-in clinic from the balance of the retail space etc., but giving consumers a strong, family-friendly reason to come into one’s premises, fix an urgent need and then to provide related products and services makes sense to me. In a somewhat related analogy, I’m reminded of my experience as a pet owner when I visit Petsmart. No only is there a ton of pet supplies available, but many stores have an on site veterinarian & grooming service available in a separate, glassed-in area. A one-stop, no-hassle destination for me when my 4-legged “baby’ is under the weather….
I would say the determining factor is if retailers value and really want the Hispanic customers’ business or not. Several LA retail companies I know are growing bigger every day by serving the Hispanic customer. These, Anglo owned retailers, go out of their way to understand the cultural differences, i.e. how the Hispanic customer shops, pays, etc. Will retailers get involved in the new walk-in clinic businesses? I think that generally, as a culture, Hispanics are loyal to those who they do business with, pay their bills on time, and appreciate honesty in return. Retailers may have to look at high profits within the clinic as a secondary advantage, catering to these individuals’ needs first of all. The traditional retail business will be rewarded later. Think of how Target stores might approach this opportunity, or the local supermarket chain, rather than a fashion clothing store which might be out of place in this arena.
For 15 years I did not have a “regular” doctor, I only went to these Minor Emergency Medical Centers. When I asked the doctor there if he could be my primary care physician, he said “No” and urged me to get a traditional doctor. I went through that process, signed up with a regular doctor, waited and waited, and went once. In the year since then, I have been to the Minor Emergency Center 2-3 times and not returned to the doctor. I would guess the audience of the place I go is about 1/3 Hispanic, like the population at large where I live (Austin), perhaps a little higher. But most of the customers are not Hispanic. They are of all ages but lots of single mothers and working men.
I did not realize this service was any cheaper than the regular doctors. They don’t position it that way. And they do require insurance or payment at the time of treatment, but so do the regular doctors. The big difference is convenience, which appeals to a lot more people than just Hispanics. My time is worth money.
The traditional system is a mess and that is not hard for customers to figure out. My experience is that the doctors at the Minor Emergency Center are at least as knowledgeable as the other doctors I have met, and work much more efficiently, in a less expensive facility. No TVs to watch in the little rooms, no fancy lounges with aquaria out front. Just a team of people getting to the crowd as fast and pleasantly as they can.
To me, there is less of a sense of being ripped off. The regular doctors always want to give you another test or see you again in a few weeks. The Minor Emergency people seem more intent on getting to the heart of the matter and getting it fixed so you don’t have to come back.
The independent pharmacy next door — which is not discount at all — is a longer wait, from all the people coming out of the emergency clinic.
I am not sure how I feel about putting them into stores. Often, customers want to park right at the door when they are sick or injured. I think what really matters is the quality of service and convenience, more than any other factor. For people of all groups and incomes.
Other than the desire to be served by someone who speaks Spanish, the other alleged Hispanic differences seem the same as other low-income people (the desire for low cost, paid care as a last resort, etc.) Smart retailers in ethnic neighborhoods will hire multilingual people to work in their medical clinics. In all neighborhoods, to avoid alienating healthy customers, the medical clinics might need separate entrances.
I believe clinics operated by retailers will receive the vast majority of their support from The American Trial Lawyers Association and the Insurance Industry. Both of these entities will make money as a result of retailer operated medical clinics. The retailer will not! The retailer will not operate clinics unless there is profit to be made and they cannot afford the overhead imposed by the insurance industry or the regulatory burden that the trial lawyers and government have created. You want affordable health care you get the insurance industry and the government out of the health care industry and make consumers pay directly for healthcare goods and services. Service will improve and cost will drop dramatically.
Walk-in clinics will not be good for business. Unless, of course, it’s closed off from the shopping public and has a separate entrance — which smacks of sending African-Americans around to the back of the restaurant to buy their food during the bad old segregationist days.
What caught my attention was Terry’s mention of “appointment-free care, even with long waits.” What retailer, especially those who sell food, wants a bunch of sick people lined up inside the store, coughing, sneezing, and spreading germs? Crying babies? Whining children who are just itching to get out of their chairs and run around? Separate bathroom facilities for those who are waiting? Not exactly a business-builder.
Our healthcare system is so broken, I find any new approach refreshing. Especially when the approach appears patient-centric. My experience with the medical system in the last year has been, regrettably, in-depth, due to ailing parents. It always strikes me that, as a patient, YOU must do what you can to accommodate the quirks of the healthcare delivery system, not the other way around. You see posters in hospitals reinforcing that the patient is, in fact, the client. But you gotta wonder what the situation is that they must display these posters. Speaking Spanish! Recognizing clients want and need acute care! Revolutionary.
The number of people in the US (not necessarily Hispanic) who visit emergency rooms because they have no insurance and no primary care physician is huge. If there is a clinic in their neighborhood that will treat them and make the experience easy by having people who speak their language, it will be a busy place!
Now what does that mean? Does it mean a more efficient health care system? Who knows? The retailers are not doing this to promote efficiency in the health care system. They are doing it to promote traffic and loyalty for their retail outlet. Does it mean that other customers will stop coming because they don’t like seeing sick people at the place where they buy their food? It depends. If the pharmacy location is near the fresh produce and other customers see people coughing and sick near unpackaged food, regular customers may go somewhere else.
What happens depends upon how the area is set up, how it is managed, how busy it is, and how well the facility integrates with other local health facilities.
While “walk-in” clinics are not new (Florida Hospital operates an excellent chain of CentraCare Clinics in the Orlando area) they represent a great opportunity for retailers to serve their communities. While culture will play a roll in who uses these clinics, the more important factors will be convenience, immediacy, affordability, and quality of health care. These clinics will be successful if retailers and the clinic operators understand that how quickly they can serve patients and the overall quality of the health care will determine their success. For CentraCare Clinics, there is a doctor present at all times. Seriously ill patients who need immediate attention are sent directly to one of the company’s hospitals.
I think unless there are big changes in our health care system, low income people will gravitate to emergency rooms rather than in-store clinics. These clinic are not as low priced as many might think. And they will expect payment for their services. Emergency rooms are still basically free for those without insurance who are invisible in our society. The patients are long gone by the time the bill is sent out.
Economically, I understand the value of doing this – but I remain very uneasy with the idea of bringing admittedly and self defining “sick people” into a place where food items are sold. Does it happen now without my awareness? Sure. But I don’t know it. As soon as my retailer begins to reach out and cater and solicit the business of treating people with communicable diseases “on-site” is the moment I no longer frequent that retailer. Am I being “blind” to the fact that those same people may shop my store now – but I just don’t know it? Yes. However, I may “know” that restaurants frequently have bug infestations or mice/rats, etc. (not a pleasant thought)…but when I SEE one at the restaurant it leaves a bigger impression on me than just knowing it is likely there.
I guess most agree that these clinics will help in reducing the overall cost of health either through cheaper care for non critical illnesses or better preventive care among all ethnic groups
Another relevant aspect of the viability of these clinics is whether they are perceived as business drivers (pulling people into stores) or as another mechanism to pass the time while waiting for prescriptions to be filled.
Also relevant will be the effect of these clinics on the emergency rooms of nearby hospitals. In the absence of such clinics many people would be forced to visit the emergency rooms for health issues like toothaches, backaches, earaches and the like….
The tie ups between hospitals and these clinics for mutual referrals may be the way forward.
To your question, “Will retailers pick up on the cultural relevance of walk-in clinics for Hispanic communities?” I defer to what the late Sen. Hubert Humphrey, Democrat, said to me when I asked him privately why he lived his personal & business lives like a Republican: “You got to do what you got to do.”
When it comes to getting customers into the store, there are lots of new products and services that have special appeal. The addition of a mini-doctor’s office will appeal to many customers, not just Hispanics. This could actually improve health care by offering non-threatening, lower-cost services to groups who, for whatever reason, avoid or delay seeking medical care.
CVS Corporation, Wal-Mart Stores, and Target are all opening in-store health clinics. These clinics are open during normal pharmacy hours and staffed by nurse-practitioners. They operate under the names of Minute Clinic, Take Care, InterFit Health, and others. Clean-up in Aisle four and check-up in aisle three are now a reality. And, remember, as long as they’re in the store, they’re gonna buy something — a prescription, OTC meds, orange juice, chicken soup, something.
This is not a Hispanic or even a cultural issue, but instead points to a “one-stop” shopping need, and the importance which healthcare in a convenient environment is demanding. This rewards both the local community of the retailer as well as reflecting on the entire retail chain. Providing these clinics within the retail environment also gives retailers a chance to “give back” to their local community, while harvesting the obvious rewards which this service provides, including the shopping “halo-effect” for peripheral services, products and promotions. Point of service care clinics are integral to both the retailers and the communities’ health. They should be considered vital from this perspective, and not limited to any one type of community.